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Case Study - Chronic Back Pain

John G, a senior public servant in his 50's, had chronic back pain. He had been to his GP, an orthopaedic specialist, two physiotherapists and a Chinese-trained doctor. A cat scan had revealed two prolapsed discs. John had been particularly diligent with an exercise/stretching program, and with trying hard to maintain "good posture". While previous treatments had resulted in some improvement, particularly in regard to flexibility, there was still lots of low back and hip pain; on walking, sitting or standing, in each case within minutes. As it turned out, a great deal of John's pain stemmed from the excessive effort required to maintain his overly rigid "good posture". John's concept of "correct posture" involved lots of tension and rgidity.

Initially the Technique brought: (1) release from pain, and (2) a feeling of wellbeing. John also noticed a looseness/freedom in the limbs which was new. John learned how to be upright (i.e. good posture) without excessive tension or "holding up". This meant he was in less pain, and movement was freer.

There was a positive reaction from others to both his general wellbeing and the fact that his posture had so clearly improved. "I now play tennis 2-3 times a week and ride my bike - these are activities which I haven't done for 10 years, which I had been told I would never be able to do again. I couldn't contemplate being able to do these activities even 3 months ago."


Case Study - Chronic Neck Pain and Overuse Syndrome
Forty-six year-old Debra C started Alexander Technique lessons to see if it would help her chronic neck pain. She had bulging discs in her neck, and tenosynovitis extending back over three years.

Debra learned to make links between her (controllable) habits of use of herself, and the functioning which they affect. She was able to progressively reduce the vice-like grip her muscles had held on her neck, allowing it to find a less strained position. Neck pain, a constant companion for the preceding 3 years, gradually disappeared. Her arms became significantly less painful. She was able to sit comfortably for longer and able to write more freely. An unexpected further benefit was a very noticeable increase in energy, as she learned to not invest energy in unproductive and pain-inducing tension.


Case Study - Self-management - Rheumatoid Arthritis
Jackie M, a 47 year-old pharmacist, started Alexander Technique lessons hoping to reduce pain levels, especially in her neck. She had suffered from rheumatoid arthritis for 10 years. She found that she was indeed able to influence her pain levels and to be more comfortable in everyday life, as well as learning a procedure to help her when things were particularly bad. Of course, the Alexander Technique did not address the rheumatoid arthritis, but it helped Jackie to cope better. It helped Jackie to recognise where she had more power and control over her situation than she had thought. Jackie found there was scope for applying her lessons in all the activities of everyday life, with valuable pain-reducing results. Her back improved generally, particularly her neck and lower back.

An intelligent woman, Jackie had been doing her best to manage her condition, including paying attention to her posture. Like John and also Debra, her understanding of what good posture consisted of, how to achieve it and how to maintain it, were all based on a series of common but potentially dangerous misconceptions. Their Alexander Technique teachers were able to gradually correct these.

 

Case Study - Voice 

Dennis is in his 50’s and in his work life he has to give presentations and be involved in many meetings. He has long struggled with a soft and fairly expressionless voice.

We started by looking at what he was doing that may interfere with his voice coming out more strongly. As children most of us have no problem with either volume or hoarseness. What was hindering Dennis?
Looking at how Dennis balanced his head on his spine, It became clear that Dennis places much downward pressure through his chest, in a way that both drags on his throat, affecting his larynx (voicebox), and also hinders the free movement of his ribs, affecting his breathing. Further, he had acquired a habit of speaking with a depressed soft palate which led to a flat tone.
Dennis worked on improving the freedom of his neck, which allowed his ribs to move in a way that was much more responsive to vocal demand. He found that he could breathe much more freely and that getting enough air ceased to be a problem. It also led to more resonance. Playing with the expression on his face, and the feeling behind what he had to say (influencing his soft palate) started to give his words a more modulated and interesting quality.
As he cultivates his awareness of how he produces his voice in ordinary situations, eg normal conversation, or on the telephone etc, he is developing a sensitivity to how he uses his vocal apparatus which is making a very positive difference to his communication skills. His presentations have become clearer and livelier.

"I have time"

 
Jane is a 50-something year-old lawyer who loves her intellectually demanding and stimulating job.  She is good at what she does, and is a diligent "trier", who had recognised, by the time she started Alexander Technique lessons, that something had to change. She was in a state of constant over-stimulation, very reactive and excitable. Physical symptoms included lots of neck tension, as well as stiff shoulders and a twingy lower  back.  She was sleeping poorly.
 

Jane started by learning to observe her body more closely, and what it was telling her about her emotional state. As she became more attuned to the difference between a tight neck and shoulders, and physical free poise, she was learning how to avoid internalising an external situation. She learnt not to translate the external situation, which is neither bad nor good, but simply is, into internal stress and tension.
 

The phrase "I have time" encapsulated part of Jane's approach. She realised that giving herself time to stay attuned to herself (starting with her body), meant that she wasn't rushing reactively into a response, but rather responding out of a more centred balance. This included specifically releasing her neck muscles and lower back muscles, many times a day. Painful stress-related symptoms - neck tension, headaches and sore shoulders have receded as she gives herself time to listen to herself more, rather than plunging into the next task. The tasks are still accomplished! And Jane is no longer at the mercy of external circumstances, but more a mistress of herself.

Staying fresh behind the Wheel

 Something I often am asked about is getting comfortable behind the wheel of the car. The following story may help you to avoid problems if you are driving some distances in the coming weeks.

Sam is 30 years-old, works in an office and is keen on keeping fit. His GP suggested he look into the Alexander Technique for help with a desperately stiff neck. It was stiff all the time, including when behind the wheel of his car. When I watched him sit in his car, it was apparent that the way he raised his arms and braced his shoulders was part of the same (tight-neck) pattern. His whole driving position was organised around "pre-tensioning" his neck.

First it was necessary for Sam to tune in to this excess of misplaced neck effort. This was a case of paying attention and "catching himself out" when he tightened his neck and "pulled his head in". Initially this was much of the time. As he noticed more often, he started to be able to control it.

Then it was time to look at the relationship between his torso and his limbs, in other words, how was he using his arms? Initially Sam found it difficult to raise his arms to the steering wheel without tensing his neck and shoulders. Being coached through this in a lesson gave him the necessary experience. Then, mindfulness when he got into the car, as he was driving, and at red lights started to bring it into focus. I showed him how he could move his arms without the tension. The feeling was, of course, unfamiliar, but on the other hand, his neck didn't hurt!

Sam's awareness of how he was doing what he was doing, at the time he was doing it, grew and grew. He started to be able to carry this though he day. In the car he was able to notice not just what he was doing with the weight and balance of his head and how that influenced his shoulders and arms, but also how he was balancing his entire torso over his sitting bones. Ensuring that his bottom was as far back as possible into the corner of the car seat was helpful to his overall driving posture.

Sam realised that paying attention to his way of driving had a positive spinoff at his desk at work, since many of the postural challenges were, in fact, the same. 

 

Hip and Lower Back Pain

Anna is in her early sixties and leads a very active life which includes gardening, cycling and yoga.  She is completing a degree at the ANU School of Art. She has always experienced problems standing for any length of time.  At 49 she learned she had a significant leg length difference. Despite wearing a built up shoe since then she started experiencing hip pain last September and now walks with a pronounced limp. She has been recommended hip surgery but wants to defer it until she has completed her course in 10 weeks and both she and her husband can give major surgery the full attention it needs.  In the mean time she was strongly advised by a friend to try AT.

Having practiced yoga for many years and done 6 years of belly dancing, Anna considered herself “body-aware”. However, it is usually the things that we do not know about, the things that we are unaware of, that are the problem. So it proved in Anna’s case.

Anna found that within a few lessons over about three weeks that she was able to significantly influence her hip pain levels. This grew from building basic self-observation skills, and being clearer about how the different parts of the body relate to one another. We started with the head and neck, emphasizing the need for freedom of the head on the spine. This allowed for a corresponding change in her lower back. Her lower back was able to relax more fully for the first time in many years. This in turn allowed the connections from her lower back to her legs to also relax, reducing the pressure in her hip joints. Having had this experience and therefore realising what was possible, meant Anna could also start to move eg bending or walking in the same way, ie with less of the damaging and pain-producing tension. Her gait smoothed out considerably, and the limp was far less apparent. Most importantly, Anna felt much more in control of the state of her body in general, and her hip in particular. She is now managing the pain rather than the pain managing her, and is no longer using painkillers.
 

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