Where is the Top of Your Spine?

11964621245_b2965f0d49_zI have a longstanding pattern of forward head positioning. And I have a job where I lean over people much of the time. And I participate in a culture that uses these pesky smartphones and laptops that have us leaning down all the time. Grrr! Fortunately my Alexander Technique teacher, Rachel Bernsen, has given me a great cue that helps me to feel my head supported on top of my body. Well she's given me many fantastic cues, but this is one I come back to many times throughout my workday. Thanks Rachel! This is for any of you out there who are starting to feel a kinship with vultures...

*Update 3/3/14: My fantastic Alexander teacher, Rachel (linked above) and I had a great conversation come out of this post, and I realized it was important to add that information here. So- the actual location of the A/O joint is back between the ears. When she cues me, she is touching my ears here, so that I can get a sense for where the joint actually moves from. When I put this video up of me touching under my cheekbones (zygomatic arches in the hiz-ouse!), what I am referencing is the level of the A/O, not the actual location. So I am talking about where on your cranium you can feel to reference the height of the top of your spine, and she is cuing where the joint actually sits and moves from. Hope that specificity helps!

Photo by Jaci XIII

Shoulders Tug of War

Woman with upper back and neck painWhen I keep seeing a theme in my practice I know it’s time to write about it here on FFF. Lately I’ve been seeing a lot of people who are suffering from pain in their neck and upper shoulders/back, and they are trying to relieve or resolve the pain by pulling their shoulders down and away from their head, only to find that this makes the pain worse. While “pull your shoulders down” doesn’t exactly make my movement cue hall of shame (like, say, “tuck your pelvis” or “lift your chest” do), it does make my movement hall of lack-of-nuance. Since that just rolls of the tongue so easily, we’ll go with that.

“Pull your shoulders down” is one of those things that many people are mistakenly under the impression they need to be constantly vigilant about. In reality, most people’s shoulders are a totally fine distance from their head, and so when they are tugging their shoulders down, in what is a chronically overtaxed and tight area for most in our culture, they wind up agitating their soft tissue instead of relieving it. It’s kind of like the tension put on the rope in tug of war. If both teams are pulling the rope is taught. Tugging harder on the rope isn’t going to make it longer, it’s just going to pull the team on the other end around while creating more force and strain on the rope. When what we’re talking about is your tissue instead of a rope: Ouch.  In short, you can’t force yourself past an end range and expect to find more space. Instead you will find more strain.

Here’s where the lack of nuance issue comes in; Yes, most of us in our culture are suffering from overworked and tight muscles in this area. Namely the upper trapezius, levator scapula, and scalenes. Plenty of other things come into play because there are no local problems, but these places are for sure gummed up and tight. And when these places are tight, they can contribute to an upwards creep of the shoulders. But things aren’t always short and tight. We can have plenty of places that are pulled long and tight, and that happens a lot in the upper shoulders and neck.

Regardless of whether you are a “long and tight” or “short and tight” person in this area, because of the sensitivity of the tissue here, tugging the shoulders down often just lights up the pain pattern. It can also be useful to know how nerve rich an area this is. In particular, the ulnar and median nerves exit your cervical spine (neck vertebrae) here to weave their way through your shoulder and down the arm. And nerves just don’t like getting yanked on.

So what to do for your cranky shoulders, neck, and upper back? First, the ultimate goal should be for the shoulders to rest, not for them to be chronically pulled downward with muscular effort. Second, giving the tissue some slack in your stretches for it often helps to unglue the area more effectively. And lastly, external rotation is your friend. Let’s talk about each one at a time.

Nuance! We like it in our movement cues! Here goes:

  • Shoulders are designed to rest. The beautiful design of our interior architecture is made precisely so that we can be supported from the inside out, not so that we need to be constantly efforting. I think sometimes we forget that the goal is to feel supported and fluid rather than to be striving in the direction of perfection (Wow I could go on a long tangent here about what that means about our cultural conditioning! Another time…). In other words, your tissue has got your back. That’s what it is designed to do. In the case of our shoulder girdle (which just means the entirety of what we define as shoulder structures), the clavicle, scapula, and humerus, and all the soft tissue that emerges from and weaves into those bones, make up this lovely structure that just rests on top of your ribcage. So before you do anything else, first ask if you really need to be pulling your shoulders down. Take a good look in the mirror. Are your shoulders really masquerading as ear muffs? Really?  In my experience, that is not the case for many people. If your shoulders seem to be a just fine distance from your head, why not give up yanking them down and see if this act of not doing actually resolves or relieves your pain. I have seen in many of my clients that when they stop forcing this corrective on themselves that they get better.
  • Give your tissue some slack. My brilliant Yoga Tune Up® colleague Lillee Chandra has a great way of describing this. She says that it’s kind of like when you have a drawer that’s stuck, and you keep yanking on it in the hopes that you’ll free the drawer to glide again, but it won’t budge. Ultimately what really frees the drawer is to stop yanking on it, and to actually push it back in until it gets back on its track, and then it slides open without the slightest glitch! A simple way to do this is by rolling your shoulders instead of pulling them down. You go through a full rotation of bringing them up to your ears, down towards your back, and then to rest in neutral. Another way to play with this is with the extreme trapezius shrug, which is in the video below and is from the Yoga Tune Up lexicon.
  • External rotation is your friend. Much of what we perceive as shoulders that are “too high” are actually shoulders that are internally rotated. Because we primarily use our arms in one configuration in our culture (out in front of us and internally rotated at the humerus while typing, texting, holding the steering wheel, carrying groceries, lifting weights, etc, etc) we tend to get stuck in internal rotation. Go back to your mirror and internally rotate your humerus (upper arm bone) as much as you can on one side. Does that shoulder now appear higher than the other side? And if you now externally rotate the humerus (the pit of the elbow will begin to face out) does that shoulder now appear lower? Magic! This doesn’t mean you need to be walking around in forced external rotation, but it can be a much more useful direction to stretch in than simply pulling the shoulders down. I also demonstrate this and talk about it in the video below.

Enjoy! And be kind to your shoulders. Give those guys a break this holiday season, ok?

And now on to the video:

   

DIY Friday: Make Your Jaw Happy

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*Do it yourself! Every Friday we do a roundup of great posts, videos, or other resources around a theme that help people to turn their bodies from cranky to happy.*

5504152401_e1df6a4387_bI do the work that I do because of TMJD, otherwise known as Temporal Mandibular Joint Disorder. You may know it better as jaw clicking, popping, locking, and pain. I had a birth injury which injured my upper cervicals (neck), and so I grew up with an out of whack jaw which, by the time I was in my early 20’s, was barely functional. I could occasionally open my mouth all the way (it sounded like a rifle going off and would attract confused stares), and for a period of a few months in a row I actually wasn’t able to open it more than a quarter of an inch; Just enough to squeeze a straw through my teeth to get some liquid nourishment in. I actually had a physical therapist tell me I would be on soft foods or even a liquid diet for the rest of my life. I was twenty-two.

This lovely condition meant that I also had severe chronic pain in my head, neck, spine, and sacroiliac joints. I was a mess. I was also very lucky to find a TMJD (sometimes also called TMD) specialist who didn’t believe in the surgery, and after building some splints to re-align my jaw is the person who ordered me to get some good bodywork (I had no idea what that meant at the time, but after researching I found my way to Rolfing®) and to learn how to meditate. To keep this DIY Friday from spiraling into a memoir, I’ll end the story there but suffice it to say, I got better, I discovered a career I love, and if you are suffering with this condition I feel your pain. For reals.

That said, I have wanted to write this DIY Friday for ages but since I am oh so passionate about TMJD I tend to go on and on and on. I’m going to try and keep it short and will save the meaty version for a book series I am kicking off this year on resolving common chronic pain and mobility issues (stay tuned!).

Ok, I’m reigning myself in, TMJD, as I mentioned, is a disorder of the jaw. It is ridiculously common, and varies from mild to severe. My case is an example of the severe range. Other people may just have occasional clicking or locking and headaches or neck pain. It also often manifests with sacroiliac pain (the dimples at your low back where it meets your pelvis), as the jaw and SI joints commonly mirror one another.

Things get out of whack in a jaw for a myriad of reasons, but injury, poorly done orthodontia or other dental work, and stress are top of the heap. Regardless of the cause, what happens is that your bite winds up not meeting properly, and the cartilaginous disc that is between your mandible (jaw bone) and your temporal bone gets out of place (the clicking you hear is when it slips back into place, when the disc does not go back into place, or if it gets folded over on itself, the jaw will lock). This also loads your musculature and fascia improperly and you wind up with pain and a gnarly full body compensatory pattern.

Because the root issue is a poorly aligned bite, in the past people in the medical world have gone bonkers and jumped right in to whittle down people’s teeth, surgically alter their TMJ in horrific ways, or even break and reset the jaw. Do not go this route! Your jaw is misaligned because your soft tissue- fascia, muscles, tendons, and ligaments- are out of alignment. This can be resolved. So before you go altering what your maker gave you, get some smart soft tissue work. You may have a severe case in which case extremely well informed orthodontia may be needed to move your teeth into the position of your new bite (I had to do this), but cases that require this are in the minority. And the surgeries for TMJD have all had very poor outcomes, and often leave people with more pain than they started with and a lifetime of repair surgeries. In short, keep it mellow and be suspicious of highly invasive tactics. Less is more when it comes to realigning the jaw.

To get your jaw aligned without invasive and unsuccessful interventions, I highly recommend you seek out one or a few of the following:

A Rolfing practitioner or other Structural Integrator: Rolfers like me graduated from the school Dr. Rolf founded, The Rolf Institute, other SI people go to different schools like The Guild or KMI. • A craniosacral therapist: People who practice craniosacral have widely varying degrees of education. Make sure your practitioner is well trained and hasn’t just dipped their toes into this form of manual therapy with a few hours or a weekend of training. • A cranial osteopath: This is brilliant and highly sophisticated work. • An acupuncturist: Not someone who has studied “dry needling” in one weekend to tack it on to their medical or PT practice. A real deal acupuncturist. If they have also studied Chinese herbs that’s a good sign of a highly educated Chinese medicine doctor.

But wait! This is DIY Friday!? Well good news, I adore this video of my teacher, Jill Miller, with Kelly Starrett of Mobility WOD working with TMJD. This sequence is profound and I would have given my right arm to have had it 16 years ago. So use it well.

A few caveats: Jill’s tissue is like silk from all the smart input she gives it, so if you are flared up with a jaw disorder, or simply if this is your first work with the therapy balls, do what she is doing but in slow motion. The therapy balls can be found here, and if you’re looking for one to buy instead of all of them the alpha (the single large therapy ball) will be your best option in this sensitive tissue as it is a broader stroke. Do not use lacrosse balls, golf balls, baseballs, or any other ridiculous hard balls in this area. This is a sensitive place!

Without further ado, I give you Jill and Kelly:

photo by Theen

DIY Friday: Losing Our Heads (and How To Regain Them)

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*Do it yourself! Every Friday we do a roundup of great posts, videos, or other resources around a theme that help people to turn their bodies from cranky to happy.*

The screens! The screens! What a love hate relationship I/we have with them! One the one hand... Um hi there! I wouldn’t even be communicating with any of you without them. Among many other things, technology has given lots of people a voice and a gathering place here in The Land of Blog, and for that I am hugely grateful.

7275218206_4888f9a1a1_bBut as an embodied person, who happens to write about embodiment via this handy computer I am currently on, ugh! Frustrating! I also notice that running 3 businesses means that I am now fully addicted to my phone as well, bowing my head to its screen as if in some weird prayer ritual a gajillion times a day to respond to emails and texts. Do I need to do it that often? No, but alas I am working on my “rat to the pellet lever” type addiction to the thing. And I suspect I’m not alone. Look around you. We are the pre-cyborgs. Carrying around our not-yet-built-in gadgets and bowing our heads down to the ever beckoning screens.

The addiction piece is a big one here, but, apologies, for now I’m going to leave you guys to grapple with that one on your own, while I grapple with it on my own. (And hey now, if you have handy tips for being less addicted, add them to the comments below). We will instead talk about what is going on when we lose our heads and how to retrieve them before we are feeling 90 years old at any age.

First, there is the obvious impact on the spine. Anyone who has had low back problems is probably very familiar with decoding what I mean when I write “L4/L5, L5, S1”. If you don’t know what I’m talking about here, I am referring to a grouping of your lowest vertebrae in your spine, and this bit of letter plus number body code speak is actually quite well known these days by laypeople because so many people have disk herniations* at these levels of the spine. In other words, if you didn’t know what I meant you are in a lucky minority. This epidemic of herniations has happened because the scourge of sitting has been going on for long enough and people do it for so many hours in every day, and improperly by sitting with a tucked under pelvis instead of on their sit bones (aka the ischial tuberosities).  But that's fodder for another post…

Back to the neck: I predict, and I’m definitely not alone here in my prediction, that “C6/C7, C7/T1” will be the new hot trend in disc herniations. I kid. But seriously, we’re headed for some trouble here (as in, we’re already in trouble here and it’s going to get worse.)  These levels of the spine are at a different transition point, right where your neck ends and back begins. In other words, right where you hinge forward when you look at your phone or your while-curled-up-on-the-couch laptop screen. We’re going to see a ton of unpleasantness here, and for those of you with kids (I’ve got a 6 year old) their generation is being primed for this at a very young age. So save yourself and your kids by starting a family project of reclaiming your heads.

Now on to the DIY:

Regain your head intervention #1:

Remember that phone prayer bow that I described earlier? Here’s how I break the cycle:

  • First, a little movement experiment: Get up from your computer and, bow your head forward as if you were looking at your phone. In other words, drop your head and narrow your gaze as if you were looking at a screen. Keep your head and vision like that and then take a little walk around the room you’re in.  Do you feel 90? Well you look 90, so knock it off. Losing your head instantly ages you everywhere, not just in your neck. You start getting shuffle-y all over the place.
  • So let’s reclaim the top of your head first, shall we? Without tugging your head up like you had some imaginary traction device on, simply bring your head back to normal (it bears repeating: do not pull your head up to the ceiling in mock good posture, or shove your chin back to flatten your neck out. This only sets you up for a different pain pattern whilst giving you an attractive double chin).
  • Now you have simply brought your head back up away from looking at the imaginary phone. If you heeded my warning about not tugging your neck long, you’re likely still a little forward with the carriage of your head. Goofy as it may feel, give yourself a gentle tapping on the crown of your head, or the very top most point of your head. This invites an awareness in of where the top of your head is. You can then gently(again no tugging!) follow that awareness to an upright head posture.
  • The top of the head is a very common body blind spot these days. Most of us (including me on my heavy phone use/Rolfing client days) lose connection to that. The gentle crown o’ the head tap is so simple but can have a huge result. Pepper it throughout your day. It may have the bonus effect of making your boss think you are having a nervous breakdown and inviting you to take a personal day. It’s worth a shot.
  • Next up (you’re still standing right? I’m going to make you walk around more) let’s play with your vision. The other thing that shuts down our body-wide movement potential is this narrowing of the gaze via the tunnel vision that exists only for the screen. So instead, start looking very consciously with your peripheral vision. Notice if that feels weird. For most of  us these days it does, because we  wear the imaginary screen blinders for such large portions of our day.
  • Keep that “looking through your peripheral vision” action going and now take a walk around the room. Don’t be surprised if you feel a bit off balance. Your peripheral vision is likely rusty, and you need to reclaim it gradually. This impacts your actual vision, but also, as I mentioned, movement potential and responsiveness (what if a ninja attacks your from the side after all?). Play with turning your peripheral vision on consciously through the day.  This is one you can do without anyone even knowing you’re expanding your movement vocabulary, so go for it.

Regain your head intervention #2:

Want a longer, more upright neck? Jill Miller of Yoga Tune Up® shows you how to lengthen the tissue on the front of your neck, mainly the platysma and scalenes muscles, which, when shortened,  are a large part of why people turn into vultures. Go slow and use broad touch with this. Imagine you are trying to slowly and gently warm up and stretch a piece of dense taffy. Rubber band snapping sensations are no good. 

Regain your head intervention #3: 

Kelly Starrett of Mobility WOD has got you covered for addressing positioning when using your phone and computer. Check it out in his post, Death by Texting. And please heed his warning when he says that he's not asking you to stick your chest out when you externally rotate your arms. Don't shove your chest forward with this! That will only agitate your neck over the long term. 

Lastly, why not cap this all off with a laugh by checking out The Oatmeal's comic on The Evolution of our Spines and Speech. Hilarious perfection. 

Go forth and use your gadgets without hating on your neck!

*Important footnote: The diagnosis of a disc herniation is, in my opinion, a hugely simplified view of what’s going on when people experience back pain. Beyond it being simply my opinion, data shows  that pain frequently does not correlate with what is going on with the discs. Often times when a thing can be easily measured, as in, “Look! There it is on the MRI!” people get told it is the whole story. But nothing in our bodies exists in isolation, so there is always a myriad of other things going on with the muscles, fascia, nerves, etc. So for the purpose of this blog I am using the simplified “disc herniation” issue to illustrate specific locations in your body clearly. It’s also handy because many people know what I mean via the diagnoses they have been given. But please know that it’s not just your discs I’m referring to here, and when you have a musculoskeletal/fascial issue it’s never just one thing. We just happen to live in a culture that loves a good bullet point. But bodies are not bullet points.

Photo by Roger G1