the lats get all the fun

This is another of the exercises I was given as part of my prescribed treatment at London, UK. Scoliosis SOS clinic.  Of course not everyone received this exercise and those that did were given various modifications according to their curves, but what was common was a good ol' lateral muscle workout on an unstable foundation.

First, a wee primer on the whys and wherefores of that particular muscle group.

The latin name latissimi dorsi is commonly known to its friends as the "lats".  Favoured by body builders, the name can be translated as "the biggest muscle in the back" (or, when it is sore, as "the biggest pain in the back", but I digress)

Here is a description of what the lats do by Wikipedia:
The latissimus dorsi is responsible for extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and (medial) internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine.

And here is a description of its function by www.bodybuilding.com:
The Latissimus Dorsi is a large "fan-like" muscle that covers those dozens of muscle that I mentioned earlier, it is therefore called, superficial. Its place of origin, or where it starts, begins at the middle of the back at the vertebrae T5-T7, the lower three ribs of the rib cage, the iliac crest (the hip), and the inferior angle of the scapula. That's a big muscle! And the whole thing runs to one single spot.

And yet another description by NYU's Langone Spine Center:
Flexion of the spine is defined as movement that produces forward bending, such as bringing the chin toward the chest or bending forward at the waist as if to pick up an object....Trunk muscles (latissimus dorsi) also participate in flexion of the vertebral column, shoulder or head movements, or arm movement. (These) trunk muscles, unlike the abdominals, attach to the spine.

Did you find that the explanations got clearer and easier to understand? Me too!  For once, Wikipedia confused the heck out of me.  But all three descriptions (and thousands more) were backed up with consistent visuals (even if artistically skewed towards specific demographics):

The Scoliosis SOS clinic talked a lot about lats, but so does my pilates teacher who says they need one of the largest percentages of work given the tasks they are expected to do, and for those with scoliosis their work is that much harder.

So the exercise I was given was all about the lats. In fact, nothing else much moves, except what is generated by the lats.

The work is more valuable when carried out on an unstable foundation (no, I do not mean my deranged childhood years!), as they have to work that much harder. In this case, that unstable surface takes the form of a large exercise ball, on which I sit.  In my case, I also have a beanbag placed under my left butt cheek (see that cute little thing in the photo?), so that my two hips are more even in elevation off the floor. I must also, of course, sit in my corrected position, with my rib cage lifted up and to the right. My knees are also bent at a 90 degree angle, with my heels directly under my knees, which means I end up with my shins pressed against the bars.  It took me a few days and many shin bruises (I am a slow learner!) to figure out that a small mat over the bars might not be such a bad idea!

In front, I hold the ends of two therabands that have been fastened to the gym bars at roughly waist height. My arms are held at a 90 degree angle, my chin is tucked, and the back of my head is stretched up as if someone was pulling a string attached to it.  Then I squeeze my lats together, trying to draw my should blades together. In so doing my arms move back and I hold the position for a slow count of 6 before releasing them back to the start point.  By the end of a set of 12 I can sure feel my back!  (A good counter stretch in between sets is the cat.)  Then I repeat for a total of 3 sets.  After which I am so aware of my lats that I feel I must go out and have a latte!

scoliosis and pregnacy

I love reading the New Yorker magazine. There's always at least one article of interest each edition, and the writing is so good.  The only thing I do not like about it is its published frequency.  Every week!  Way too much pressure to finish one before another arrives on the doorstep!  I get my mother's cast offs and that way do not feel rushed.  The negative of this is that sometimes it takes me so long to get to them that I am reading a February edition in October.  Small price to pay I say.

Just this afternoon I was catching up and reading an old copy (only 6 weeks old - practically up to date!) that included an article by and about a woman who never really wanted to be a mother and wrestled with that.  Some of what she said resonated with me and it made me quite sad.  Not drink an entire bottle of merlot sad, but pensive. 

When my scoliosis was first detected I was 19 and it was deemed either too late or too early to do anything about it.  The specialist who confirmed it had just two things to say to me: be active, and you might have a hard time giving birth as it is unlikely you will be able to receive an epidural.

At 19 and a dancer I was already on board with advice #1 and advice #2 just seemed so far into the future to worry about.

As it turned out I married at 33: "late in life", and becoming a mother, which I had always assumed would take place several times, became high on the "to do" list.  But it didn't happen.  Two years later I went through a barrage of tests, and the only thing that came of it was "you have scoliosis" (duh), "you have a lot of endometrial scarring" and "your uterus is heart-shaped".  Whaaat?  There it was, drawn on a scratty piece of paper by the doctor just after a laparoscopy, drawn for me as I came out of unconsciousness and was trying very hard to look like I had all my senses.

What do I make of that?  There is some evidence that endometriosis impacts the ability to become pregnant.  But it's not absolutely prohibitive.  Same thing with a heart shaped uterus, which is rarer, but not impossible.  And despite what many people who do not have scoliosis say, it in no way impacts conception.  I know quite a few people who have both scoliosis and children, although they did confirm the fact that giving birth is not always so easy.  Many have had caesarians, and it's not because they are "too posh to push".

We determined to do everything modern science allows, at least once, as most things cost many thousands of dollars.  In vitro fertilization, where multiple eggs are induced, harvested, allowed to mingle with husband's sperm in a petrie dish, and then re-introduced into the maternal body.  Nope.  Intra-cytoplasmic sperm injection (ICSI), a brand new procedure that did all of the above except that one specific sperm was chosen per egg (strong swimmers with everything intact).  Uh-uh.  Donor insemination, whereby someone else's sperm is injected.  We had quite a bit of fun going through the anonymous but descriptive file and eventually chose someone who liked to dance and to cook and who shared our basic colouring.  Nada.  6 times nada. 

There were other things, but the bottom line is I will never find out if I can or cannot take an epidural.  Why am I telling you all of this?  As I had been told delivery is really the only major concern with pregnancy and scoliosis, I wasn't really prepared for the emotional roller coaster of just trying to get pregnant.  No one was able to figure it out as none of the separate ingredients were detrimental, but collectively they seemed to be.  So I am a happy aunt and godmother and mentor and influence.  My marriage is rock solid.  I have been able to do things I wouldn't otherwise have been able to do and anytime someone complains of motherhood and expenses envy for my life I say "Snap!"

But what was pregnancy like for those others with curves who could conceive children?  What did they experience?

I asked around and ended up getting about as many answers as curves.  Medically speaking, there is little information in the literature on the impact of scoliosis on male or female fertility. There is also no correlation between the progression of one's curves and her age at first pregnancy. Pain was cited as a limitation on sexual practice, which produced some negative effects on relationships. With a bit of education on different sexual positions that lessen pain, and some empathy to ease embarrassment during unclothed intimacy, there really should be no problem with conception.

There are a few issues around pregnancy. A few of the women I talked to had much more back pain in pregnancy, but then some did not notice any more pain than usual. One woman said her curve grew noticeably worse during pregnancy and she is quite worried about the idea of having a second child. For those who had rods in their backs, it was difficult to push at the birth, because getting into a sit-up position was particularly hard to do.  Two of these had to be given oxygen as their lungs were compressed with the curvature and the baby pressing on them.  Several of the women were recommended to stop at two children, given the toll taken on the back.  The one I spoke to who had more than two children regretted it as her curvature is considerably worse as is the pain.

One young woman was recommended to have the fusion surgery but was so keen to have babies that she got pregnant and had major sciatica, spasms, and was almost bed-ridden with pain before having a premature baby. She then had the surgery (worse than giving birth was her comment) but has since had baby #2 with no real complications.

I was intrigued to hear the (second hand) thoughts of a chiropractor who adjusts infants and newborns.  She said that being pulled from the birth canal can cause the babies to experience subluxations in their flexible spines, and scoliosis further down the road.  !!!  That theory might have to be a separate blog post!

A read a research paper finding that scoliosis can increase pregnancy risk as the uterus expands, further impeding the natural upward displacement of the diaphragm and reducing vital capacity and residual volumes. It's difficult for these women's bodies to find room at the inn due to skeletal narrowing, particularly in the thoracic cavity. Breathing is often harder and may require ventilatory support.

A genetic disorder called EDS (Ehlers–Danlos syndrome) cropped up in the paper as relevant.  EDS is a defect in the production of collagen, or of those protein that interact with collagen. The collagen in connective tissue (arteries, skin, intestines and the uterus) helps tissues resist deformation, and so is important for physical strength of skin, joints, muscles, ligaments, blood vessels and visceral organs; abnormal collagen renders these structures more elastic.  Pregnant women with both scoliosis and EDS (severe) might find risks related to uterine hemorrhages/rupture, miscarriage, and premature deliveries due to cervical incompetence.  Depending on the degree of scoliosis (referred in the paper as "spinal deformity" - thank you for making me feel even worse), c-sections are generally prescribed to avoid shifting the body's centre of gravity during birth, and increased joint discomfort.

For those who have EDS-associated scoliosis, it was recommended to take combined oral contraceptives for their added estrogen benefit for EDS-related osteoporosis. Severe EDS and limited mobility due to scoliosis runs the risk of thromboembosis. Caution was give to the teen female population with this as they are establishing bone mass.

Actually the thing that came up with each mother without exception was that the back pain and deepening curvatures of their scoliosis became worse with the early years of motherhood: bending down awkwardly, picking up young children, twisting and carrying things beyond comfort.  Needed refusions are not unusual, and neither are considerable amounts of medication.  One of them said that quite frankly she wished she had adopted a puppy!

Breathing is harder than you think

Breathing is important for those with Scoliosis.  That's not to say it isn't without merit for anyone else, of course.  But breathing in a conscious, specific manner may add years to scoliosic lives.

I spent a bit of time of this subject in an earlier post, outlining "rotational breathing".  But since then I have been given some different images to try out, and have also had a year or so of practising.

Every activity I do it seems requires me to breathe in a conscious, specific manner that's different from all the other conscious, specific manners.  It's not just as simple as 'in out and forget it'.  In my singing classes I am told to breathe in so that my diaphragm extends down into my belly.  In choir (especially for the high notes!)  I add extra air to expand my lungs, which then are kept firm on the slow exhale until after the diaphragm is back under my lungs.  In yoga it is all about breathing into the belly, making a "Buddha belly".  In pilates it's about expanding the rib cage, back and sides too (i.e., lateral breathing), on each inhale through the nose, then exhaling out through the mouth with the effort of whatever exercise I happen to be doing.  For running and race walking and cycling, it's about keeping the chest fairly upright and open and breathing regularly. And for swimming it's about regulating the exhalation so that I don't run out of air. For me it is anyway.  I am the first to admit I am not a competitive swimmer!

But breathing for scoliosis requires another mental image, one that is very specific to each individual curve.  The best way to do this is in "puppy pose":

Get on your hands and knees.  Stretch your hands forward so that your torso is on a long angle, with your butt up over your heels at a 90 degree angle.

Start by squeezing out all the air in your lungs as if you are wringing a wet towel dry.  As you take a long, slow breath in, focus that breath into your concavity, the collapsed part of your back or side.  Feel the breath push that part of your body out as far as you can push it.

As you exhale the image becomes that of a spiral. Imagine the air leaving your concavity, then swirling across to the other side of your back, spiraling from your "hump" down and around to the front of your chest and out your mouth. 

As you breathe in in this way you are stretching the muscles that are not stretched enough on your concave side.  Then you are sending your breathe forward and out, depressing the overstretched high side of your back, the "hump" down and forward.

The best thing to have is a strong good friend who will stand over or behind you as you sit in puppy pose, tap or touch you on your collapsed side as you breathe into it. then as you breathe out they press hard down and forward on your other side.  This helps with the imagery, making the desired breath direction really felt. But it also helps on the exhalation to help those muscles that are overstretched to work differently.  It might look easy, but it's really not - you need to work hard to isolate specific muscles and then press down with your arms as you breathe the spiral of air out.

puppy pose from above

As habitual activity continues to promote its effects on the muscles being worked, doing 10-15 minutes of breath work every day will eventually work some muscles differently and make a positive difference to your body shape.  And this can actually make a life or death difference!

As you age your collapsed side becomes more collapsed and the twisted side becomes more humpy and twisted.  Depending on your individual curve that means that your ribcage might twist around so much that your ribs squeeze your heart, resulting in a heart attack, or your ribs might puncture a lung. 

Regular breathing exercises will work to prevent that from happening by keeping the lungs free and open, and the muscles around them strong enough to resist the pull of gravity.  And who can resist sitting in puppy pose for a quarter of an hour!

scoliosis en pointe

I recently read of last month's announced retirement of prima ballerina Wendy Whelan from the New York City Ballet Company.  Not that she will retire from dancing.  After all, she's only 47. 

this is what 47 looks like - to only one woman on this earth!

In July of this year 2014, a very good friend of mine in London got tickets for us to see La Wendy at Covent Garden, dancing in a series of pas de deux with four different choreographers.  At one point, I remember her bending forward for a nano-second and was struck by the sight of one shoulder bone raised higher than the other.  This registered to me and I thought "I wonder.....nah! It's just me being hyper-sensitive."  That's because it's something that I have, and other scoliosis sufferers as well.  When we bend forward one side of our backs is higher than the other. 

However, upon reading the program afterwards I found out that Wendy Whelan does indeed have scoliosis.  How did I not know this???

Apparently she found out at 12 years old that she had severe scoliosis, and at that age thought she now had a name for a disease that was causing the leg pain she had been feeling.  She was put into a heavy body brace, but oddly enough was told to continue with her ballet classes as a way to strengthen her muscles. Having already having had several years of ballet lessons was a plus, as she already had learned how to carry an uneven body, to adapt, to develop keen balance, even shoulders, strong leg muscles, stable pelvises (or is it pelvi?).  To give the appearance of a long, straight back. 

it is oh so faint but you can see a slight curve to Wendy's back here

I wonder if this is one of the reasons my own scoliosis wasn't detected until I was 19.  All those ballet and modern jazz classes - 13 years worth by then!  Maybe I had just learned how to compensate, how to intrinsically know when my head was off centre or one shoulder or hip was too high, and had become too good at hiding my imbalance. It was only when I bent forward in front of my mother that it was noticed.

Wendy Whelan has referred to the scoliosis treatment she went through as a teen as "the medieval torture chamber", with stretching machines as well as her rigid brace and a series of demanding exercises in a ballet regimen that was her only escape from the brace itself, as well as massage, acupuncture, and hot baths.  One week a month, she had to go to the hospital and spend 20 hours a day in traction. Then she'd get plastered up in her body cast again and sent back home to live a "normal" life.

Lots of ballet mad young girls are now being taught the single most important lesson all we twisted sisters and brothers need to learn - how to do simple, deep breathing exercises that get our diaphragms moving up and down and our ribcages expanding with a full inhale through the nose and exhale out the mouth. Preferably at the beginning of each day, when the spine can find centre more easily. Breathing for scoliosis is now second nature to me and my body definitely feels looser than the days when I forget or can't make the time.

Let me reiterate: The best thing in the world to do each am is to rise, brush your teeth, wash your face, drink a glass of water and do breathing exercises - about 10-15 minutes should do it.

Marika Molnar, founder of New York's Westside Dance Physical Therapy and director of physical therapy at the New York City Ballet says she knows loads of professional dancers with scoliosis and doesn't see it per se as a problem. Of course having a twisted spine means a dancer has to have an acute body awareness and a good eye (in the mirror) and sense (when not in a mirror) to correct problems that arise when one seeks the bodily perfection of a ballerina.
La belle Wendy is refreshingly open about her scoliosis and has become a bit of a leader to those of us who always thought things like professional dancing was out of the question.  She gives credit for her current strength to all those years of training and going to class in that horrid heavy plaster cast.  Braces are much softer now of course.  It's still an archaic and dubiously successful form of treatment, but at least its stigmatized and helpless sufferers are slightly more comfortable. (I am saying this with a acidic drip of irony by the way)

Huge kudos to Wendy for sticking it out.  Having a positive attitude of course is huge. When she was student at the School of American Ballet, she was encouraged to look up to the then principal dancer at the New York City Ballet, Heather Watts, who also had scoliosis patient.  Oh how lucky it is to find a real live hero or heroine at the right time and place!  It must have been a enormous lift to the spirits to see someone with the same body issue go on and succeed in such a demanding and public profession. Wendy knows that she has certain strengths on certain sides that are particularly visible to her because of her scoliosis. "I'm always having to pull my right shoulder back, for example, especially when I'm turning. It curves to the front and I have to really open it up."

When asked about her body's eccentricities she replied, "I think my scoliosis gives me character--it adds something to the way I move. And even when I do feel the crookedness in my spine at my age, I don't let it bother me--it's just part of who I am."  And who she is is a 47 year old dancer with the body of a 20 year old - and a 20 year old professional dancer at that - who both deals with and embraces her scoliosis. What she is is a hugely successful ballerina and an inspiration to young dancers and would-be dancers who also have scoliosis.

Brava!

 

On my mark Starfleet Officers, Engage Core!

Every time one I hear some fitness teacher say something about engaging one's core I can't help but think I have teleported to a Star Trek episode. And my days of wearing a jumpsuit are long past, thankfully for the rest of the world!

The first time a pilates teacher (who wasn't very good I now know) told me to engage me core, I sucked in my stomach as hard as I could. I was not corrected, which is why I now know she wasn't a very good teacher.

Anatomy lesson here: This is a body's core:

Whoops, how did that get in here?  Okay, quick change - this is now a Botany lesson.  The slide you see is what is left after someone has eaten a fruit of the Malus domestica, a very widely domesticated fruit tree known in English as an apple. The centre bit of the fruit, seen here, is known as the "core", which could well have come from the French word "Coeur" which means "heart".  A "cris de Coeur", in English, means an anguished cry of distress or indignation, which is what I generally produce every time I am asked to engage my core. 

That's better!  Oh my yes, that is much better!!!  ...........

Sorry, I lost my train of thought there. 

Now while this human specimen looks like he has a core that's so engaged it's practically married, that might not actually be the case.  Sorry, handsome, but overdeveloping your surface muscles until they are as tight as a drum might actually do the opposite of any intention other than to impress, as it's actually the smaller muscles inside that matter more if this guy is going to see old age upright and strong.

The so-called "six pack" muscle, the rectus abdominus, is the deceiver.  The real deal is the transversus abdominus - that's the one you need to work on if you have any hope of helping your body do what the spine is not completely able to do for those of us with scoliosis.  The obliques are also incredibly valuable in propping of the aging, scoliosis body, but when someone says "engage your core" they are generally looking at your transversus.

Life's travels have taught me that no knowledge is wasted.  One of my pilates teachers told me engaging the core is a little like the sensation of trying not to pee.  "Put your pee squeeze on" she'd intone as we grunted through an abdominal workout. 

A massage therapist said to think of it as if your internal muscles in that region of the body were picking up the four corners of a tissue, a sort of cupping lift from inside. 

And a little sprite of a dancer told me to engage from the base of the abdomen and pull up, not in, so that belly button moves higher.

A wonderful bit of advice came from a yoga teacher with huge eyes and a thick Scottish accent, telling me to feel my abdomen muscles work like they do just before I cough.  

So now when I am told to engage my core, I start to make a pre-coughing movement, moving my abs up from the inside, all the time I am trying not to pee while pretending the same pee muscles are trying to pick up a tissue.  Of course by the time I get all this done, the exercise is well on its way and I have to catch up, but I expect it will get faster with time. And I know that working in this way will strengthen and stabilize my body way more than trying to get a  row of rippling abdominus rectus muscles going. 

And that, my friends, is boldly going where no one has gone before....Now, on my mark "engage core!" (cue music)

Yoga for curves

Quick - when I say "yoga" what's the first thing that pops into your mind?

A guru seated on a mountaintop?  A group of nuts-and-berries hippies saying "om" on a beach?  A room of 100 leotard-clad fit freaks showing off their cores in their lunch hour?

Whatever it is (mine was the first one), yoga is a word everyone knows, whether or not they practice it.  The word itself: "yoga" is a bit like the Hawaiian word "aloha" in that it seems to mean almost anything.  Its origins are Sanscrit, and can mean "listen", "unite", "connect", (but not "invitation to fall asleep" as some would have it). There's also evidence to suggest the word derived from the word "yoke", as in yoking horses or oxen, and became synonymous with yoking mind and. The activity of yoga (i.e., "the practice")  is designed to bring your physical, spiritual and mental worlds together with the goal of elevating both your brain and body. 

It's pretty old.  Older than your mother.  About 5,000 years old it seems. And for something that crawled around the world person to person and community to community, it's not overly surprising to know that there is no one type of yoga.  Try over a hundred!  Since appearing in the western world in the late 19th century and flourishing since the 1980s, these types have been distilled to a few main ones: Hatha, Iyangar, Ashtanga, Tantra, Bikram, Kundalini. Then there are the ones that have crept up much more recently: Power, Prenatal, Yin, Restorative, etc. but it's pretty clear to what these devote attention.

There is more, much more to know about Yoga and its origins etc. and I do not pretend to be any kind of expert on it - I can only speak to my own experience.

When I thought I had a IT band running injury, one of my running mates suggested yoga as a way to stretch and strengthen it beyond pilates.  I love in Vancouver, and there seems to be about 18,000 yoga teachers in town.  Everyone seems to be a teacher or practicing to be a teacher.  I'm quite surprised I'm not one myself.  And just like anything else, there are yoga teachers and yoga teachers. Some teach in huge classes with everyone crushed into mat-sized space.  Some teach it like an aerobics class.  And some wander around the class (good) but get distracted by someone's problem with an exercise (bad) and forget everyone else in the room is holding some whacko pose for what seems an hour of pure hell.

But persevering pays off.  I finally found the teacher for me. She has small classes and each pose moves smoothly to the next one.  She has humour and grace, and her cueing is perfect - she always seems to say "relax your jaw" or "soften your gaze" at the exact time I am doing whatever it is I should not be doing. She also can pull out a modification for every single move and for every single individual's struggle. 

It is different than pilates in that it moves slowly and is more devoted to holding a position rather than moving though it with repetitions.  With all the strengthening and stretching, I find it a perfect complement to pilates and have gained benefit from both.

For scoliosis the benefits are clear, especially when you have the right teacher and the right exercises with the right modifications.  The muscles that need strengthening get what they need and the muscles that need stretching get that too. No teacher would ever say "only work on the side of the body needing work" but I always add a few extra seconds to whichever side needs more of whatever particular exercise as needed. 

And - and this is a big AND - the practice of yoga has a special gift for those suffering scoliosis (and any body issue really).  In yoga you are in the moment.  You concentrate on your breathing and your body in the space it operates in.  If some other thought enters your busy mind, you are directly to let it pass through and out, so you are always brought back to the here and now, and accept your body as it is, at that moment, in that place. 

This was big.  Huge.  When I was going through depression due to a supposed running injury that would not heal and no one knew why and then it was determined that it was really caused by my scoliosis and that wasn't doing to get better but rather worse, that one hour of yoga class a week kept my mind focused on what I was doing right then. Not about the scoliosis or the doctor or what my future might be, but about right now.  All those thoughts were stilled and I just listened to my breath in the body I have.  And accepted the wonderful body that I inhabit.

Because everyone has stuff.  My stuff just happens to be scoliosis, but it's surprising to find out that everyone has stuff, at some point in their lives and maybe all their lives.  Yoga is not about fixing our body in any way, but rather making the best of it as it is, in tandem with our minds and spirits. 

If you come out of any yoga class feeling jazzed, or exhausted or jittery, then you have the wrong class and/or the wrong teacher.  I exit my classes feeling calm and yet energized, open and at peace with myself, and my body. It's a wonderful feeling to forget the negative and embrace the positive, even for just a little while, and I highly recommend it.

 

Photo source: royalty free stock photos at dreamstime

Reassessed

I spent the most wonderful two weeks in Italy, celebrating my sister's 50th with her and her excellent friends in a Tuscan villa for one week, and then visiting Florence and Venice for another week because I was there anyway.  When one finds oneself in the vicinity of beauty and history one does not question one's path.  All roads lead to Rome.  Well, no that's not quite right is it?  Although all the roads that are straight in Italy probably do lead to the capital city, my path ran a little curvier (being a twisted sister) to encompass those two cities deserving of way more than a mere week.  But we take what we are given and are thankful for it. 

But I digress.  Being on that side of the Atlantic I included a visit to my in-laws and an appointment with Scoliosis SOS for a reassessment of my back and body condition.  I had finished my 4 week course in May 2013, and this was July of 2014 so it would be reasonable to expect a positive change n'est ce pas? 

However,

I had fallen down the stairs in a previous episode about 6 months ago and contracted a nasty hip bursitis. My physio and doctor and pilates teacher all told me to be patient, do my exercises and slowly add in new challenges over the months.

Doctors in general have my deepest sympathy when dealing with grown adults suffering a fall or a hit or other similar accident.  I really do.  They know what they are doing.  The exercises prescribed are no doubt the bee's knees of exercises for whatever condition they are presented with. But some patients (and I'm not going to name names here, a lot of the men in my life!) seem to question the diagnosis and prescribed plan of action, responding as if a plumber just returning from a long day clearing a stubborn clog in the pipes of the local high school had decided to practice what he had learned on TV and hazard a guess by looking at you and maybe poking you a bit with his monkeywrench. I would not be surprised if a few doctors take to the bottle when dealing with someone who argues over what they have vs. what they think they have, or over what they are told to do instead of what they actually do.

But I am not one of those patients. If I am told to do something or take something you can jolly well expect that I will do just that.  Complete a series of contortions every morning upon rising?  Done.  Add a few minutes to the daily constitutional each week?  Okey-dokey.  Don't rush to the next level of exercise until the body is secure in the previous level?   You betcha.  But even the best patient in the world (and of course I won't exaggerate, but I really am the best!) starts to wonder if this thing is ever going to get better and what's it all about Alfie?

I approached the familiar door at Scoliosis SOS's site in London's still not charming Tower Hamlets will a little trepidation.  Having had to exchange a lot of back exercises for a lot of hip exercises for the best part of the spring, would my back receive any positive news at all? 
 
The answer I received was No. Well, not really.  A bit actually. ????

Measurements indicated my lumbar curve had not changed one bit.  This, I was told, should be no surprise as lumbar curves are the hardest to move and take a long, long time of hard work.  My height had not changed, nor my weight (which was pretty awesome news actually after two weeks in Italy!). 

However, there were a few minor shifts to the positive here and there. My lordosis had improved slightly.  My waist came in a little bit on my convex side.  My shoulder blades were a little more defined and the skin over them had softened slightly. Not exactly barn breakingly fabulous news but ok, I'll take it graciously. This was all to the good.  But as soon as I told my physio du jour about my fall and Bursitis, he sucked in his breath and said "Ooo, that's a nasty injury.  Better be patient with that one.  It will probably take a year or so to heal.  In that case you are really doing well!"

So back home I go, looking at another 6 months of work, hoping to get back to where I was just before I fell, if not better.  I can now walk about 20 km during a day of sightseeing, as long as I include a few sit downs here and there.  My next challenge is biking at the gym and swimming, only one at a time, and only for 10 minutes to start.  Dancing is the last thing to add, unfortunately, as I miss it the most.

But good patients don't complain.  We do what we are told and keep climbing.  The meek will inherit the earth but the patients with patience will be able to rush ahead hold the door open for them.

The Road to Healing

Suffering a stupid injury (stupid because it was my own fault) is a lesson in just how robust and yet fragile our bodies are.

When you watch athletes compete (as I did in the first days of my injury when I could only sit or lie down and so inhaled every single event at the 2014 Olympic Winter Games that was possible through television emissions and internet streaming!) or when you see dancers or acrobats, it is easy to think that there is no limit to the feats of strength, flexibility or finesse of movement of which a human body is capable.  Children in the playground seem to be always falling down.  Adolescents spill down ski slopes in a torrent of snow dust and suffer no more than a strain.  Even well-toned adults slip, bump, tip, crash in sometimes elaborate displays of physical ineptitude, and are up and at it again within days. 

Listening to some of the Olympians interviewed, I couldn't imagine how on earth they could have shattered their knees, or broken their back, and spent months in casts before rigorous training to get back in their sport to compete.  The fact they can walk at all is amazing let alone careen down ice on what looks like a tea tray at the Olympic games.  One woman said her family motto growing up was "Safety third!"  Despite loving that motto, I wondered at the highjinks that family must have got up to with that as their watchword.  Imagine the family crest!!!

My husband's running coach is a case in point.  She was young, she was fit, she was training for her first Ironman competition, and then she was hit by a truck.  She broke her back, her pelvis and a limb or two and suffered nerve damage as well.  After a long year of recovery though, she didn't just get back to running or cycling, she took part in triathlons and ironmen as well as competitions with ridiculous comic book names: super spartan, and tough mudder.  Not only did she take part in them - she was winning them!  She ran when she was pregnant and she has the Guinness world record for the fastest marathon while pushing her first born in a stroller (<3.5 hours BTW)!

If you want to know more about Allison Tai, be my guest: http://www.allisontai.wordpress.com

But my point is that the human frame can take a lot of abuse and yet come back to fitness and strength. 

On the other hand,

Why is it that one childish body can withstand fall and after fall and then one day, the fall is different for some reason and an arm gets broken?  Strong swimmers accidentally swallow a bit too much seawater and within a minute can be lost.  Hockey players hit the boards just a tiny bit harder than usual and what normally is a bruise is now a concussion. 

I wonder about those Olympic bodies in 30 years time.  After suffering terrible injuries, will they be able to even move when they are 60 or 90? 

If I had fallen the same way in 20 years time, I have no doubt there would have been a break or a fracture.  And the older a body gets, the closer to a death sentence that can be.  Once a hip or knee is broken and gets replaced, the other is at risk, muscle mass is lost.  And as we age it gets harder and harder to get any of that back.  It's brutally unfair that it can take months of hard word to be able to plank for a few minutes or lift your own body weight, and poof!  Just like that, it is gone!

So I have followed the advice of some of those crazy fit people and set myself challenges.  The first one was being able to walk to the bathroom.  Then to shower myself.  Then to dress.  Climb stairs again.  Get in the car.  Drive the car.  Walk 10 minutes, then 15.  Garden. 

Nothing fancy or dramatic. Not even noteworthy to anyone else but myself really.  There are no medals at the end.  No interviews.  But a newfound appreciation for this crooked, inflamed, bruised body of mine.  And patience interspersed with work to help it return to its former self.  If not better!

A Knock Down of a Set Back

This Twisted Sister has just encountered a big ol' curve ball in her back care regimen.

Tuesday, late afternoon, I had just returned home from a massage therapy session, my first in almost 11 months, and started down my basement stairs, when I slipped and bumped down, top to bottom, the entire set of stairs.  Bumpety-bump.  12 steep, narrow stairs to the bottom. My husband was behind me (no, I was not pushed!) and remarked later that my fall was quite a spectacular.  He said it was impressively chilling to hear me grunt in pain as my lower back hit every stair and I landed in a heap at the bottom, crawling in pain and uttering "ow, ow ,ow" until the damage could be surveyed.

What didn't help me was the fact that I had a pear, a plate and a knife in one hand, my cellphone and a clutch of papers in my other hand, something else - can't remember what - under one arm, and was half turning to say something to my husband as I started down our stairs.  Did I say they were unusually steep and narrow? It's an old house and things were not built to what we would call "code". In other words, I should be lucky they were at least of similar size and height.

But did I let go of any of the things I was carrying?  NO!  Why the heck not?  This, my friend, I do not know.  It has something to do with the way my brain is wired. Obviously "don't drop it" was a more successful childhood admonishment than "be careful".  My elbows were purple and brown after hitting the stairs trying to save the things in my hands.  As it happened, the plate did break (no doubt due to its proximity to the wood of the stairs every time my elbows came into contact with it - it might have escaped breakage if I had let it go) and my hands and face were bleeding with several small cuts made as I clutched pieces of a broken plate.  Every thing else was just fine - even the pear had not a mark on it.

I showered and sat with an ice pack the rest of the evening, happy that everything still moved so nothing was broken.  The next day I hobbled slowly around the house, able to water plants and edit documents.  And then the real pain hit.  Deep bruising down my entire back and buttocks, bruised elbows as aforementioned, and a left hip so painful I can't help but cry out every time I moved.  The act of sitting down and standing up are particularly bad.  There is no discolouration, but it is swollen as well as painful. That third night I lost it, the pain so bad I almost fainted and I cried to my husband to help me get into bed.

My Mom had been a nurse once upon a time, and I asked her advice.  "Go to Emergency." Exactly what my husband had been saying for days.  Sorry dear.  You were right.  Well, that's what Moms are for. But how to get there?  One car is too low for me to even consider getting in and out of, and the other car is in the shop.  I can't walk more than a few shuffled steps so no bus or subway. No taxis either - I can't sit down that low. So it's Dad and his Subaru to the rescue. That's what Dad's are for. 

It was not the most romantic way to spend Friday evening, but I was finally wheeled in for a series of Xrays to determine if anything had been fractured.  Then a wait while they were being examined.  When the doctor came back she looking quite ashen and commented a little tentatively how curved my back was.  For a spilt-second I thought of opening my eyes wide and replying "Curved?  My back isn't curved.  What do you mean?"  But I couldn't play a trick like that on her, and certainly not with someone who has the power of making me take an enema.

The bad news is it will take at least a week of waiting before anything more can  be done.  The good news is there is no fracture.  But the bad  news is the swelling and the pain have to subside.

But the good news is the 2014 Winter Olympic Games are now on in Sochi, Russia.

So guilt-free Games watching!



At Emergency Friday night with my techni-colour bruised elbows

Hanging Around in Bars

When I was ready to order a set of exercise bars, my UK-based Scoliosis SOS clinic gave me the card of Artimex Sport (http://www.artimexsport.com/en/index.php) a company that makes all sorts of sport and gymnastic bars for all sorts and sizes of walls.  They would ship worldwide, but the cost of course would be more than if I lived in the UK. 

But their site provided a link to their North American rep, Artimex USA which is actually called InFitness Equipment (www.infitnessequipment.com). They have built their own supply chain, with bars made of solid wood (usually maple or beech) as opposed to engineered lumber.  And happily their model #253 is what my correspondent tells me is designed for low ceilings.  I smiled hearing that as some of my Scoliosis SOS cohorts in England might consider 6 and a half feet a good height for any room. It was shipped out that day, received a few days later and was incredibly easy to put together really. It fit in the room with 1 whole inch to spare!  Because the bar unit stands at at six foot seven, my five foot six inch body is not going to be able to hang with my whole body stretched long, but I will be able to hang with my knees bent, so my back will get the stretch it needs. 

The trick was installation.  I like to think I've retained my girlish figure into adulthood.  But let's be real - I am going to hang from it and pull on it and generally use all my strength against it, so it's got to be skookum (i.e., "strong" in local Native Indian parlance).

The wall I chose had a good strong stud on one side, but had nothing to fit it to the other side. 

A friend of a friend came in and built out my wall, moved an electric outlet, and added a full length mirror to "mirror" that of the clinic setups.

Clinic wall bars

A couple of hours later and ta-da, I have my own private gym. 

I think I will call it "Jim"

Enter stage left: Pilates! And stage right. And from above. And from below.....

Pilates is an exercise program designed to build strength in the so called "powerhouse" of the body: the roughly rectangular shape of the torso, from shoulders down to the thighs. It is all about strengthening those parts of the body that support us most, and at the same time increase flexibility and balance.

Because the emphasis of pilates is on pelvic and spinal alignment, it can be a very good thing indeed for someone with scoliosis.  However.....(don't you hate the fact there is always a "however"?)  not every pilates exercise is good for anyone let alone someone with a bit more curves on one side than the other.  A good instructor will know how to modify an exercise for both range of difficulty and range of possibility depending on what your body is capable of.  Intensity and dexterity can be increased over time as the body conditions and adapts to the exercises. 

If the previous paragraph was not clear enough, allow me to reiterate: It is really, really important to find a pilates instructor who is qualified, and ideally has either experience with scoliosis or with physiotherapy.  Do not tinker with the internet, youtube videos and how-to handbooks.  These are not a good idea for anyone actually. 

Pilates is designed to wake up all those little muscles that don't get worked because the big ones immediately get in there and activate. So if something happens to them or when they start to break down, there is nothing underneath that can keep you upright and mobile.  An introduction to pilates should start with the basics, including how to breathe (I kid you not!  It was soon apparent to me that I have been breathing inefficiently all these years. It's a wonder I'm still alive) 

The powerhouse muscles are the transversus abdominus (the muscle that runs between the ribs and the pelvis), the multifidus (next to the spine in the lower back) and the pelvic floor muscles. Focusing on these muscles strengthens the body core from the inside, like constructing a scaffold, which is not only good for degenerative disc diseases or rehabilitation from a back surgery, the sorts of things that inspired Mr. Joseph Pilates to begin with, but is also the ticket for those with scoliosis. And just as poorly constructed scaffolding that isn't well designed or tailored to an individual building will end in disaster, exercises that are not taught correctly and to a patient’s unique back diagnosis could result in even more problems.  And haven't we problems enough without adding to them?
 
Work one-on-one if you can or in a very small class to determine what your body needs. Anything that is difficult is probably important for you. And if you are sore the next day, remember what exercise made you sore, 'cuz that's the one you probably need most!

Exercising with good posture is absolutely vital in pilates. There's a constant need to remember to keep your neck relaxed, your chin tucked, your lats. down and firing, your abs. taught but not tight, your glutes relaxed, etc. etc..... Pilates demands such intense mental focus so that you can control each movement throughout an entire sequence, connecting movements between one or more specific parts of the body and the mind while also paying attention to breathing, bending, extension, rotation and flexing of the spine. Looking at someone lying there seemingly taking a coffee break, it may look easy, but do not ever say so or you will get a dark look and perhaps a swift uppercut to the jaw.  Pilates is no walk in the park!

Precision is essential, so that the muscle intended to be worked does the work and doesn't allow a larger, stronger muscle to take over.  It is far better to do only a few exercises in perfect form than a hundred reps. in poor form.  This is particularly important for those with scoliosis, as there will no doubt be exercises and thus modifications that are actually detrimental to a particular curve.
Avoid the tendency to think larger is better; working in flexion and extension works well. For every action there is an equal and opposite reaction (there you are Dr. Mosley - I did remember something from your physics class!) Having scoliosis means you should not be surprises to find that rotation and side-bending will always be limited in one direction. In most cases it is best to exercise both sides the same, but do the side that needs it more.
 The goal of course is to eventually exercise in a form and posture that has become second nature, and that can be carried over into everyday life.