Posts tagged Health
New Study: Alexander Technique Lessons Alleviate Chronic Neck Pain

A new study published in the Annals of Internal Medicine shows a significant reduction in chronic neck pain after lessons in the Alexander Technique.

517 patient with chronic neck pain were assigned to one of three groups. The control group received the usual care: physical therapy and prescription drugs. A second group was assigned 20 one-on-one, 30-minute Alexander Technique lessons (600 minutes total) with a certified teacher. The third group was assigned to 12 acupuncture sessions (also 600 minutes total).  On average, patients made it to 14 of their 20 Alexander lessons and 10 of their 12 acupuncture sessions. 

Patients taking Alexander Technique lessons and those receiving acupuncture both experienced more than a 30% reduction in their chronic neck pain. A 25% reduction in pain is considered clinically significant. As Time points out in their coverage of the study, physical therapy and exercise lead to only about a 9% reduction in pain.

The most important result from the study is that the benefits of Alexander lessons persisted after lessons had ended. Patients completed their Alexander lessons in about 4 to 5 months after the start of the study. A year after the beginning of the study the patients were still experiencing a reduction in pain. 

Stuart McClean at the University of the West of England in Bristol discussed the study with Reuters Health and suggested that the Alexander Technique helps “patients change past behaviors and habits and lead towards improved coping strategies and self-care.”

The lead author of the study, Hugh McPherson, explained that the results of the study were too robust to be the result of the placebo effect. And none of the participants in either Alexander Technique lessons or acupuncture sessions experienced adverse effects of any kind. “No other single treatment is known to provide long-term benefits,” Hugh McPherson told Reuters.

These kind of large, randomized studies of the Alexander Technique are rare. This is the first study of its kind to be published since the ATEAM study of back pain published in the British Medical Journal in 2008. That study found that back pain sufferers experienced significant relief from as few as 6 Alexander Technique lessons.

Such studies are confirming what Alexander Technique teachers have been teaching for 100 years: learning to improve your posture and movement habits can have a significant impact on your health.

See also: "Lighten Up" or "Pull Up"? A New Study about the Alexander Technique and Parkinson's Disease. And: That's Right: Nothing is the Solution to "Text Neck"

Body Learning Podcast: Violinist and Alexander teacher Andrew McCann on his early experience studying the Alexander Technique.

I had the pleasure of talking with Robert Rickover on his Body Learning podcast about my first experience studying the Alexander Technique. We talked about what inspired me to take Alexander lessons, some of the things I learned in those early lessons, how my Alexander lessons helped me as an aspiring violinist, and the ways in which those first lessons continue to influence me as an Alexander teacher today. 

My conversation with Robert was partly inspired by a series of posts I wrote about my lessons with my first Alexander teacher, Carol McCullough. I studied with her for a year-and-a-half before deciding to train as an Alexander teacher.  You can read the series here: http://www.alexanderand.com/blog/2014/11/18/my-first-alexander-lessons

Visit bodylearningcast.com for more conversations about all things Alexander. Robert Rickover also runs the Complete Guide to the Alexander Technique at alexandertechnique.com.

Walk Like A Penguin

Tablet Infographic's intermittently viral advice on How to Walk on Ice:  www.tabletinfographics.com/#/ice/

After a month of record-cold temperatures here in Chicago, we’re finally beginning to thaw out. Almost as if to celebrate, an infographic appeared on one of the Alexander Technique Facebook groups with advice on how to walk on ice. On the left, the graphic shows how walking on ice with the front foot forward increases the risk of falling. Whereas on the right, there’s a penguin. Wait a second: a penguin? We’re supposed to learn how to walk on ice from a PENGUIN?

Before I get too carried away, I should say that walking like a penguin when on ice is pretty good advice. In fact, if you experiment with not letting your forward foot get too far in front of you when walking in normal conditions, you'll be all the more prepared for walking on ice in the winter! 

But since seeing this infographic, I’ve become obsessed with what it says about the state of modern humanity that we're taking cues about walking from penguins.

People—penguins are not good at walking:

This is not to diss penguins. Penguins are wonderful creatures. They have, unlike other birds, evolved to swim with extraordinary agility. Emperor penguins, to give one example, will launch themselves from the water onto the ice to avoid predators (like the truly terrifying leopard seal).

But on land, penguins are TERRIBLE at walking—penguins expend twice as much energy on land as any other terrestrial animal of the same size. Penguin legs are short and their feet are big. While longer legs would help a penguin walk more easily, it’s thought that long legs would also lose heat too quickly in the harshly cold environment in which many penguin species live. Waddling looks comical, but it turns out to be the best way to walk if you have really short legs.

In contrast, almost every aspect of the human body has evolved to facilitate efficient walking. Our long necks and tall narrow waists allow the head, ribs and hips to move independently from each other, facilitating the pleasing spiral swing of a healthy walk. The curve of our lower backs—the lumbar spine—positions the torso directly above our pelvis and legs, rather than pitching our torso forward, like in our closest cousin, the chimpanzee. Our human pelvis—the illium—faces sideways and our knees are angled underneath our hips. This allows us to balance our weight on one leg while keeping our trunk upright. And we have a large heel bone—the calcaneus—and well-supported arches, that allow us to roll through the foot and push off the front toes.

Human beings as a species may not be as adept at swimming as penguins, but we are much, much better at walking.

Human adaptations for efficient walking. This image has been modified from Lieberman's The Story of the Human Body to include...a penguin.

It’s particularly bizarre to look to penguins for help with staying stable on ice because there’s so little consequence for a penguin when they slip. It’s one of the delights of watching penguin blooper reels that they fall without injury—even from a significant height. And a penguin falling on its belly introduces another form of locomotion—tobogganing

It turns out that an animal’s size and its danger of injury in a fall are linked. An animal the size of a mouse, amazingly enough, can fall any distance without risk of significant injury. My 15 lb cat has swiped a bug off the ceiling from a high shelf and then leapt the 10 feet to the ground to eat it with little concern. A 40 to 80 pound emperor penguin can trip without fear. But adult humans aren’t so lucky. Any animal above 100 kg (220 lbs) will be at serious risk for injury from a fall of just its own height—picture a horse, cow or elephant. While adult humans weigh less on average than 100 kg, we are quite tall for our weight. Adults can break bones just from tripping, and falls are the leading cause of fatal and non-fatal injuries in seniors above the age of 65. 

To help keep us from falling, we have rescue (or righting) reactions. These are automatic—though most likely learned—reactions to keep an animal from overbalancing. Rescue reactions have been studied in many animals—cats and dogs seem to be the popular laboratory preparations. (Even bats have been studied—though since they sleep upside down, they do not share the same righting reactions common in other mammals.) Rescue reactions in humans are very robust, triggered by information from multiple senses: not just the inner ear (vestibular system), but from the eyes, head balance, sense of body position (proprioception) and touch (such as the contact of the feet on the floor). There are many rescue reactions, from staggering and bracing the legs, to sweeping the arms. “If the limbs are trapped, the trunk will be moved so as to take the impact on the shoulders,” balance researcher TDM Roberts tells us. “The movements are organized as though to avoid impact with the skull at almost any cost.” 

Rescue and righting reactions are studied in the laboratory in many ways, including putting subjects on a "tilt-table." The image is from TDM Roberts Understanding Balance, p. 163.

In December of last year, I experienced my rescue reactions when I stepped on a sheet of black ice walking home from a gig. At the moment my foot began to slip, I felt my arms shoot out and my legs brace of their own accord. I stayed on my feet. I felt particularly lucky because I was more encumbered than usual. I was carrying my violin on my back, my courier bag over my shoulder with my wife’s laptop in it, and a grocery bag with a pyrex that had contained my dinner. Disaster averted.

So if we’ve evolved to walk well and we have well-ingrained rescue reactions, why do we need a tutorial on how to walk on ice? Obviously, winter is dangerous and ice is slippery. But winter is dangerous partly because our built environment is so safe.

Two winters ago, Kyra was leaving the morning after one of those wintry-mix storms that leaves equal parts snow, slush and ice on the ground. She strapped her cello to her back and stepped out on to the front porch with extra caution. But when she reached the stairs, she went flying, not because she wasn’t prepared for the slippery stairs, but because she didn’t expect the hand-rail to be covered in ice as well. She was lucky. Though she landed on her chin, she suffered only minor bruises. She also provided another instance towards a possible hypothesis: that musicians modify their rescue reactions to protect their instrument first, their own heads second.

My near slip in December was a similar point. The black ice was hidden in the shadow of a street lamp. The rest of the sidewalk was clear. The situation was only half-safe, but I expected it to be completely safe, so I nearly fell. This is true of much of our modern environment: an expectation of safety brings with it inattention and complacency. (There’s a similar effect in roadway construction—boring flat roads are more dangerous than dangerous swervy roads because people drive more safely on dangerous swervy roads.) 

Is there one best way to walk on ice? Tutorials on the ‘correct way to move’ are a byproduct of standardization, only sensible in a manufactured landscape. Better to think of unlearning our habits—trading the one wrong way not for the one right way, but for the ability to choose from many possibilities.

With enough time, such modern conveniences can actually change our bodies and our reactions. Researchers in Europe have found that seniors who have lived their lives in cities with cobblestone streets are less likely to fall than seniors who live in cities with smoothly paved streets. Cobblestones are more precarious, they demand attention and adaptability.

Our habitats create our habits. Before studying Alexander, I walked as if still slumped in a classroom chair: head forward, upper-back leaned back, hips forward as if about to “limbo.” Many people walk like this, or in some other strained way. 

The problem with such habits is that they it become our default way of moving, whether the sidewalks are icy or the sidewalks are clear. Looking back on my near fall in December, I wonder: If I still walked with my hips pushed forward, would I have slipped on the ice? It's hard to say. But walking with your hips forward—already out from under you—is a fall waiting to happen.

So is there one best way to walk on ice? Tutorials on the “correct way to move” are a byproduct of standardization, only sensible in a manufactured landscape. Better to think of unlearning our habits—trading the one wrong way not for the one right way, but for the ability to choose from many possibilities. Better yet to practice taking notice of our environment, not slip into a too easy inattention.

I went for a walk this morning down to Lake Michigan, about a mile from my apartment. For most of the way I had little choice but to follow the sidewalk. Trucking along the cement ground, I could experience simple walking, my bipedal inheritance in action: the free balance of my head on my spine, the swing of arms and torso over my hips. I could experiment with walking that was a gentle fall forward, or mix it up and bring my attention to the thrust of my toes from behind.

When I got to the lake, though, I left the sidewalk. Even in flat Chicago, the parkland is gently rolling. The ground is uneven. Most all of the snow had melted from the slight rise overlooking the lake. My feet sank into the muddy ground at odd angles. Though I was still walking, my gait was as changeable as the terrain—here stepping around a puddle, here high-stepping my knees over an unmelted chunk of snow, and once, yes, swaying from foot to foot over a patch of ice, like a penguin.


Thanks to Alexander Technique teacher Jennifer Roig-Francolí for sharing the How to Walk on Ice infographic. I turned to Daniel Lieberman's The Story of the Human Body for a guide to human adaptations for walking. The relationship between animal size and risk of injury in a fall comes from Steven Vogel's Life's Devices: The Physical World of Plants and Animals. Rescue reactions are described in TDM Robert's Understanding Balance. Studies on falling on the cobblestone streets of Europe came from the Blakeslee's The Body Has a Mind of Its Own. And the tidbit about drivers driving more safely on more dangerous roads is found in Tom Vanderbilt's Traffic.

If Evolution is to Blame for Back Pain, Why Do We Even Bother?

Alexander Technique students often experience relief from back pain through lessons. But if evolution is to blame for back pain, are we just deluding ourselves?

One day in the spring of my final semester in college I was in a hurry to check my mail between classes. I started running from the conservatory to the mailroom and after barely half a block, had to stop because my lower back hurt. I am tall and slim, much like my dad. When I was growing up, he suffered from periods of lower back pain, so even though I wasn’t particularly active or fit in college, I didn’t think, “Boy, I need to get in shape.” I thought instead, “Well, I guess it’s my build.”

This way of thinking about pain and discomfort is pretty common: my problem isn’t because of how I do things, but because of who I am. When it comes to back pain, this way of thinking has gotten a boost from some evolutionary biologists. They argue that evolution is to blame for back pain.

I’m glad I didn’t know about this line of thinking back in college. If I had, I wouldn’t have just thought: “My back hurts because of my build.” I would have thought, “My back hurts because I’m human.”

What do evolutionary biologists mean when they say that evolution is to blame for back pain?

In popular culture, it’s common to think of evolution as a perfecting process, where our species just keeps getting better and better all the time. But evolution—at least the natural selection kind—is a blind process. Species don’t get better or worse: they adapt to what is. When the environment changes, species either evolve over time to fit it or don’t. Most importantly, new adaptations in a species are constrained by what has come before.

For example, in the recent Cosmos series, Neil deGrasse Tyson explains that eyes originally evolved in water. When animals emerged on land some 375 million years ago, evolution couldn’t start over and “design” eyes for the land. Terrestrial eyes had to evolve from aquatic eyes: and so humans, to give one example, can’t focus on something that is held up right in front of our face. Who knew?

Such constraints on evolution explain the origins of back pain in humans. Our primate ancestors were quadrupeds. Our upright stance and bipedal locomotion are recent adaptations. There just hasn’t been enough time for our backs to have adapted to being upright.

Bruce Latimer, an anthropologist and anatomist at Case Western University, makes this argument to LiveScience. "We're the only mammals that spontaneously fracture vertebra," he says, comparing the spine to a stack of cups and saucers (the cups are the vertebrae and the saucers are the intervertebral disks). He continues:

Then take a book like a dictionary and put it on top. This is the head. If you are really careful, you can balance it — otherwise there's a lot of porcelain on the ground… Then imagine taking this and putting in all the curves that you naturally have in the spine. I could give you all the duct tape in the world, and you still couldn't possibly balance it.

Latimer is featured on Neil Shubin's wonderful PBS series Your Inner Fish. (It is currently streaming on Netflix.) PBS has made a three minute clip featuring Latimer available on youtube:

If our backs are an "engineering nightmare" (strong words!), does this mean we can’t do anything about back pain? If my Alexander students experience relief from back pain in their lessons, are they just deluding themselves?

In his 2013 book, The Story of the Human Body: Evolution, Health, and Disease, Harvard evolutionary biologist Daniel Lieberman suggests that back pain might not be as inevitable as it seems.

Bipedalism first evolved some 6 million years ago, when our hominid ancestors, Ardipithecus and Australopithecus, first stood upright. Approximately 2 million years ago, the earliest human-like hunter-gatherers emerged, including Homo erectus. Modern humans, Homo sapiens, evolved some 200,000 years ago. Lieberman notes that there are important anatomical differences in the spines of Homo sapiens and Homo erectus, specifically one less lumbar vertebra in Homo sapiens, which implies that there was evolutionary pressure selecting for stronger spines in modern humans.

To Lieberman, two predominantly cultural changes help explain the high incidence of modern back pain: the agricultural revolution, 11,000 years ago, and the industrial revolution, some 200 years ago. Lieberman argues that back pain is a “mismatch disease” that results when our evolved adaptations fail to match the demands of our modern, cultural environment. Our hunter-gatherer ancestor’s lives were neither as rigorous as early farmers nor as sedentary as our contemporary lifestyle:

He writes:

No one has yet quantified the incidence of lower back pain among hunter-gatherers, but foragers rarely sit in chairs, they never sleep on soft mattresses, they often walk while carrying moderate loads, and they also dig, climb, prepare food, and run. They also don’t engage in hours of strenuous work such as hoeing or lifting that repetitively load the back. In other words, hunter-gatherers use their backs moderately—neither as intensively as subsistence farmers nor as minimally as sedentary office workers…

He refers readers to Michael Adams' model of lower back pain risk, then continues:

A healthy back requires an appropriate balance between how much you use your back and how well your back functions. A normal, fit back needs to have a considerable degree of flexibility, strength, and endurance, as well as some degree of coordination and balance. Since people who are mostly sitters tend to have weak and inflexible backs, they are more likely to experience muscle strains, torn ligaments, stressed joints, bulging disks, and other causes of pain if and when they subject their backs to unusual, stressful movements.

Lieberman’s account fits with my experience of back pain at the end of college. Like many college-aged Americans, I had been sitting everyday for hours upon a time for a decade and a half. When I sat in class I leaned back with my weight resting on my tail bone and my lower spine in a c-curve. Yes, my back hurt, but not enough to send me to a doctor. Even so, years later, Joan Murray (the co-director of the Alexander Technique Center Urbana where I trained as an Alexander teacher) would tell me that when we met, my lumbar spine was almost kyphotic (that is, the normal curve of the lower back had been reversed).

First in my Alexander Technique lessons with Carol McCullough and later during my training with the Murrays, I re-learned my basic coordination. In the process, my lower back strengthened and my shoulders broadened. I developed greater comfort in a wider range of positions. I still remember the excitement when I developed enough mobility in my hips and knees and length in my back to squat with my heels on the ground. And the lower back pain went away. I’m more comfortable in my body now as I approach forty than I was at twenty-two, about to graduate from college.

The process wasn’t magic. I relearned how to move and gradually reversed a condition brought about by neglect. And my renewed coordination requires maintenance. But since I make my living from teaching the Alexander Technique and performing on the violin, I'm not tied to a chair the way I was in school. That said, certain situations are more challenging than others.  As I learned the hard way, when I’m performing eight shows a week as a violinist in a pit orchestra, I need to make sure that my setup (my chair, my stand, my violin chin rest, etc) makes healthy coordination possible.  

The evidence from evolutionary biology does suggest that humans have a risk for back pain. But Bruce Latimer and others overstate their case when they blame evolution for back pain and call the spine an “engineering nightmare.” A risk of pain doesn’t mean that we are destined for pain. If we let it, our modern school and work environments will leave our backs uncoordinated and weak. But we don’t have to become victims of sitting all day. With practice, we sedentary moderns can relearn how to move so that we not only avoid pain, but experience real joy in movement. After all, something else evolved along with our dodgy backs—our minds.

Daniel Lieberman discusses back pain as a mismatch disease in the chapter 12, "The Hidden Dangers of Novelty and Comfort" in The Story of the Human Body. The PBS series Your Inner Fish was originally a book, also by Neil Shubin. The most significant study of the Alexander Technique and back pain was published in the British Medical Journal in 2008 and has been summarized here.
 

Tone Poem

I’ve been struggling for the last few days to write about muscle tone. Muscle tone is all important in the Alexander Technique—but how to evoke it? Make it palpable in writing?

Technical writing is technical. From Tim Cacciatore, et al’s “Improvement in Automatic Postural Coordination Following Alexander Technique lessons in a Person with Low Back Pain.”

The AT aims to improve the “use of the self” by teaching conscious control of tonic muscular activity in relation to actions and events through 2 main principles: (1) the prevention of undesirable increases in tonic muscular activity that are triggered by actions and events (“inhibition”) and (2) the use of conscious, spatially directed motor commands to influence tonic muscular activity (“direction”). Alexander claimed that these principles, when integrated, achieve and maintain a definite, balanced organization of tonic muscle activity that underlies efficient coordination.

Tonic muscle activity. Muscle tone.

What is muscle tone? Here's a trick from chefs for judging the doneness of steak: find the fleshy place between your thumb and first finger. Relax your hand and touch the spot. Rare. Bring your thumb against the side of your palm so that the muscle tones. Medium rare. Grip tightly until the muscle bulges. Well done.

Is muscle tone like musical tone? E. Geoffrey Walsh tells us:

The word ‘tone’ has the same root as the word ‘tune’, and the tension in the tendon of a muscle can be likened to that in the string of a guitar. Based on these considerations, muscle tone in the resting state can be measured by applying rhythmic forces and observing at which rate of application the motion is the greatest. This is the ‘resonant frequency.’ Tone is related to the square of the resonant frequency.

Though I am a musician, I don’t really know what to make of this. Each day I take the violin out if its case. I tighten the hair on the bow—not too tight, not too loose. I check the A against the tuner, then tune the other strings, each a perfect fifth. Two strings vibrate together in a ratio of 3:2. When perfectly in tune—not too slack, not too taut—the resonance should fill the air. No audible beats.

Muscle tone has a history. Kyra was a competitive gymnast for five years. Watch a gymnast dismount: feet driving into the mat, knees locked, hips pitching forward, lower back arched more than it seems possible to be arched. Not just muscle toned—muscle taut. It has been 18 years since Kyra last competed, but the pattern is still there. Yesterday she practiced letting the pattern go. She asked her legs to let go of her low back, to stop pulling it forward into an arch. Somewhat surprisingly they agreed. They let go. Enormous relief, but very disorienting. She both felt more stable and like she might not be able to stand. She went to bed but her legs wouldn’t let her sleep. They felt underemployed. They were looking for something to do. Something to hold on to.

Muscle tone is a state of being. Awake. Asleep. It was the fall of my first year training to become an Alexander Technique teacher. Brinn was only a few months old. His mother, Katie, was in her third year of training and he often came with her to class. I was twenty-five and clueless about babies. One day it was time for Katie to get some work from Joan, so Katie passed Brinn to me. He started out alert, looking around, springy in his body. Where had his mom gone? He could still see her so he started to relax. It was late in the morning. I felt his body start to soften. He rested his head on my shoulder and fell asleep. What chemical is released by the feel of a sleeping baby against your shoulder? I wondered. I was soothed as well. (Stacy came in the room, whispered to Joan: “I’ve never seen Andrew so quiet.”)

Muscle tone is mind. There are so many possible stories. Here's a simple one: I’m visiting the Murrays for a teacher refresher course last June—continuing education, as it’s called. I’m receiving a table turn: I’m lying on my back, head supported on a book, knees up. I’m happy to be a student again—get some work, not just give it. Margie lifts my right leg off the table and I let her have it. It’s relaxed in her hands. Then Joan calls from downstairs. In five minutes we’ll be assembling for the morning demonstration. Margie laughs. Though my leg still rests in her hands, though I haven’t moved it an inch, I’ve taken it back. My leg has filled with sudden purpose. It is all readiness: Time to get up. Time to go to work.

Muscle tone is all of these things. Working with my Alexander students, we discover muscle toned to tautness, hard coils of rope from years of working too hard. We find muscle so underused it has grown slack. Above all, we find muscle without mind. Muscle that is a mystery to its mover. And so we work to wake up. Ask the necessary questions. Give instruction. Redistribute the load.

Do you see the importance of muscle tone? How the work is more than posture and positioning? More than a collection of parts in the right relationship: 90° from here to here, 135° from here to here. More than alignment? It is about fully inhabiting your being. It is about being completely alive.

Tim Cacciatore study, "Improvement in Automatic Postural Coordination Following Alexander Technique Lessons in a Person with Low Back Pain," was published in the journal Physical Therapy, June 2005. E. Geoffrey Walsh's thoughts on muscle tone come from the Oxford Companion to the Body, 2003.

"Lighten Up" or "Pull Up?"; A new study about the Alexander Technique and Parkinson's Disease.

Word came last week about a new study published in the journal Neurorehabilitation and Neural Repair about the Alexander Technique and patients with Parkinson’s Disease.

Parkinson’s Disease is a progressive neurological condition affecting movement. Progressive in this sense means that symptoms worsens over time. The condition often begins with slight tremors and reduced facial expressions and may eventually lead to a stiffening and slowing of all movement. Parkinson’s is largely treated with medication, though Parkinson’s patients and their doctors often explore methods that can improve a patient’s quality of life while coping with the disease.

The Alexander Technique and Parkinson’s has been studied before. In 2002, a randomized control trial published in Clinical Rehabilitation assigned 98 Parkinson’s patients either to 24 individual Alexander Technique lessons, 24 individual massage sessions, or no intervention beyond their normal drug treatment. The study showed that Alexander lessons significantly increased the ability of patients to carry out everyday activities (there was no significant change in the massage group). The benefits remained when patients followed up 6 months after their lessons ended. The Parkinson’s patients who took Alexander Technique lessons also had less change in their Parkinson’s medication than either of the other groups (this is notable since medication dose usually increases with time as the disease worsens). The patients themselves reported improvements in balance, posture, walking, and increased coping with the disease and reduced stress.

One of the challenges in a randomized control trial like the 2002 study is to explain why a particular intervention is effective. In the 2002 study, massage was used to control for the effects of touch. Though massage and the Alexander Technique use touch quite differently, they use an equivalent amount of touch in a session. Since the Alexander Technique had a beneficial effect but massage did not, the researchers could conclude that touch alone wasn’t enough to benefit the Parkinson’s patients. The patients who took Alexander Technique lessons clearly learned something, but what?

Enter the most recent study: “Lighten Up: Specific Postural Instructions Affect Axial Rigidity and Step Initiation in Patients with Parkinson’s Disease,” by lead author, Dr Rajal Cohen. (You can read it in full here)

This was a smaller study and deceptively simple: 20 patients with mild to moderate Parkinson’s Disease practiced two contrasting postural instructions for all of ten minutes each. One set of instructions, called “Pull Up,” was based on effortful conceptions of posture. The other set of instructions, “Lighten Up,” were based on the Alexander Technique of releasing into length.

The research team then measured axial rigidity (increased axial rigidity interferes with movement), postural sway (sway can increase the risk of falling in Parkinson’s patients), and the smoothness and efficiency of initiating movement.

The study is fascinating to anyone who is interested in movement and posture because it shows that how we think about posture can make a measurable difference in the quality of our posture and movement.

During the study, the Parkinson’s patients read contrasting explanations for the two separate set of instructions. The “Pull Up” instructions were based on familiar conceptions of posture:

Parkinson’s makes you weaker, so it is important to activate your core muscles to pull yourself up to your full height. For the next few minutes I would like you to focus on feeling your neck and trunk muscles work strongly to pull you up.

The patients then practiced these specific “Pull Up” instructions (which might be familiar to anyone who has worked with either a personal trainer or a drill sergeant):

Use your core muscles to pull yourself up to your fullest height; engage the muscles in your abdomen and lower back; feel your neck and trunk muscles working to pull you up; pull your stomach in, your head and chest up, and your shoulders back.

“Lighten Up” instructions were based on the Alexander Technique. The researchers had the subjects read this explanation:

Whatever our condition, we make matters worse by pulling ourselves down, and especially by tightening the neck and pulling the head down. For the next few minutes I would like you to focus on allowing an upward direction.

Then the patients practiced the following instruction:

Notice that you are pulling yourself down and give yourself permission to stop doing it; let your head balance easily at the top of your spine; allow your spine to be uncompressed and your torso to open effortlessly; let your shoulders and chest be open and light.

As a control, the researchers had the patients practice a “relaxed” condition:

Imagine that it is the end of a long day and you feel tired and lazy; allow your head to feel heavy and sink slightly forward and down; relax your shoulders and allow them to hang heavily.

The researchers varied the order in which the patients practiced “Pull Up,” “Lighten Up,” and “Relaxed,” to control for possible carryover effects from the different instructions. What did they find? When patients practiced “Lighten Up,” they showed less axial rigidity, less postural sway, and increased smoothness of initiating movement than when they practiced “Pull Up” or “Relaxed.”

There are a couple of surprising things about these results. The authors note that since Parkinson’s Disease has such a detrimental effect on motor control, they did not expect the patients to show a measurable difference when practicing something so subtle as differing postural intentions. Most remarkable to me is that such brief instructions, given without the hands-on guidance found in a traditional Alexander lesson, would have a beneficial result. The study gives some inkling of why a course of lessons—like the 24 lessons in the 2002 study of Parkinson’s patients—might be so positive.

One of the things that excites me about this study is the way in which it clearly articulates the difference between how Alexander Technique teachers approach posture—lightening up to make things easier—versus more familiar approaches to posture—pulling up to make you stronger. We Alexander teachers often feel like we are in danger of getting swept away in the great wave of “core conditioning,” struggling to prove the benefits of a gentler approach to movement than “power through” and “no pain no gain.” If this study can help convince people that lightening into length has proven benefits, it might help not only Parkinson’s patients, but anyone who wants to move more easily and effectively.

Pas de Clarinette: Histories of Movement

When I was a new Alexander teacher, I worked with a clarinetist who was in her mid-twenties. Since I knew she was a musician, I was on the look out for habits that I associated with wind playing. Maybe her head would go forward towards her mouthpiece or—since her clarinet’s weight would be carried by her right hand—there would be an imbalance in the shoulders. But the first thing I noticed was that her feet were very turned out. She tended to pitch her hips forward and hyperextend her back. Because her hips were tilted, she sort of leaned into her belly, even though she was quite diminutive and didn’t have much of a belly. I was a little bit puzzled, so I asked her, “Have you ever studied ballet?” And she replied, “Oh yes, for about six years when I was a kid.” Even though she hadn’t studied ballet for well over a decade, she still stood in first position.

One of the first things I now ask new students is to to share their history of movement. The habits that we look at in Alexander Technique lessons are not the obvious habits—like our eating, smoking or drinking habits. They’re our habits that are so close to us that we take them for granted. One way to uncover these habits is to take stock of our history of movement: reflect on what we have done with enough regularity over the years—especially in our childhood—that the habits we formed then are still around now.

Musicians can be particularly interesting examples of layered movement histories. I once worked with a cellist in a workshop. He was clearly a skilled and knowledgeable player, but he seemed to be playing in spite of his torso, which was quite rigid. He held his breath while he played—which wasn’t particularly unusual since so many string players hold their breath—but when he did breathe, he would gasp in the air with great force. Because it was a workshop, I didn’t have time to take a complete movement history before we started. So we worked on what was in front of us—getting him to notice his breath and let it move freely while allowing his torso to move sympathetically with his arms as he played.

It was when I talked to him later that I learned that he had been a competitive swimmer through much of high school and college. His specialty had been the sprint events and, as he told me, in a race every unnecessary breath slows you down. So his overarching goal when he swam was to get to the other end of the pool with as few breaths as possible. He hadn’t swam competitively in many years, but his breathing habit in the pool had carried over into his cello playing. His rigid torso suddenly made sense: he was playing the cello as if he was swimming a race, only breathing in the rare moments when he came up for air.

One of the interesting things to me about these two examples is that both dance and swimming have positive associations in our culture. We speak of the grace of the dancer. Swimming is often held up as an ideal form of exercise. And while dance and swimming can be beneficial in many ways, they can also lead to habits that are far from healthy. No one is immune from the power of habit. After all, it’s not what you do, it’s how you do it.

In many styles of dance, especially ballet, dancers may wittingly or unwittingly cultivate a hyper-extended back, an anteriorly-rotated pelvis, and turned out legs. If a dancer has these habits and becomes a wind player, they will have a harder time finding the release in the lower torso necessary for a full recovery of breath.

Competitive swimming is all about speed in the water. I can't speak to whether it’s a good idea to hold ones breath during a meet or not. But if competitive swimmers have to hold their breath, they should take care not to bring that habit into their other activities.

Much of Alexander work is about unlearning: taking away the habits that interfere with the task at hand, whether it’s performing on a musical instrument or something else entirely. There’s a parable that Alexander teachers like to share. A young artist goes to a master sculptor and asks him, “Master, how do I sculpt an elephant?” And the master replies, “Take away everything that doesn’t look like an elephant.”

 

Chair Follies & Sondheim's Follies

I picked up my music last week for Newsies, a touring Broadway show that’s coming to Chicago to start a month long run on December 10th. It got me thinking about the first show that I played in town three years ago: Stephen Sondheim’s Follies at the Chicago Shakespeare Theater. It nearly killed me.

I’d been freelancing in Chicago for seven years when I got called to play Follies. The life of a freelance musician can be very feast or famine, so the prospect of solid work for six weeks was exciting. When I say it’s solid work, I actually mean it’s a lot of work: eight to nine shows a week, with only Mondays off. That means double performances on Wednesdays and Saturdays, sometimes Sundays. I knew I was going to be tired, but I was pretty confident that my Alexander training had given me the know-how to get through all the performances intact and healthy.

The first couple of band rehearsals went well. When we joined the cast for the sitzprobe we were on stage for the first time. Follies tells the story of a reunion of old theater performers, and the director Gary Griffin had decided to put the musicians on stage with the actors, so that we seemed like the reunion band. Space was pretty tight: the band was terraced up the back of the stage. I was down on the lowest terrace between Ben on harp and Jill on cello. There wasn’t a lot of space between my music stand and my chair. I had to sit back in the chair in order not to be straddling the music stand with my legs.

It wasn’t a great chair. It was sturdy enough, but the seat sloped backward. That wasn’t ideal—it’s hard to be poised on your sit bones if your chair slopes back. The chair was a little low for me and the cushion, though firm, was thick: my butt sank into it so that my hips were below my knees. The worst part, though, was the back, which was on a spring hinge, and would lean further back if you put your weight on the back of the chair. I didn’t like the fact that I couldn’t rest against the back of the chair without going into recliner mode. But I was an Alexander teacher—I knew how to sit in a chair. Didn’t Alexander himself say something like (and I’m paraphrasing), “We educate people, not furniture.” Plus, this was my first show. I didn’t want to be that guy, complaining about his chair.

We had a dress rehearsal on Tuesday afternoon and then our first preview performance Tuesday night. Afterwards, my back was pretty achy. The next day we had two previews and after the second show I was in bad shape. My back did not feel good. I limped back to my car, feeling old.

I knew that I was probably playing a little tight—it was my first show, after all. But I wasn’t particularly nervous or stressed out. Yet by the end of the Thursday show, my back was hurting like it had never hurt before, a dull ache that wouldn’t quit. I had a friend visiting from out of town, and after the show all I could do was lie on the floor on my back and wonder how it could possibly be so bad. I was not being a good host.

It wasn’t just my back that hurt. My ego was taking a bruising, too. I was an Alexander teacher. I’d been studying the Technique for 12 years. I had been a certified teacher for 8 years. As a teacher, I had helped students overcome back pain. And here I was, three performances into my first run of a show and my back hurt so much I couldn’t stand. I was a fraud.

I did everything I knew how to do. When I practiced during the next day, I stood up to stay mobile. I did lots of lie-downs. I was going to keep it together. But three quarters of the way through the next show, my back was hurting so much it felt like it was going to give out. Halfway through Losing My Mind, I was thinking, “I’m going to lose MY mind if my back hurts like this for the next six weeks.”

Like I said the chair was cushioned, but the front lip of the chair had a metal bar running underneath the cushion. In desperation, I sat up on the front of chair, so close to my music stand that I was in danger of knocking it over with each down bow. But as soon as my butt touched the solid support of the chair’s edge, I felt this connection shoot up my spine from my sit bones to my head. The relief to my back was instantaneous.

The Stefan chair: nothing special, but it gets the job done.

I also looked a little ridiculous. For the rest of the show, I played sitting on the lip of the chair, looking like I was about to embrace the music stand. After the show I went to Bruce, the Stage Crew Supervisor, and told him I needed to swap out my chair. There weren’t any other options at the theater, so I brought one of my simple black Stefan chairs from home. As tired as I got as the run went on, my back didn’t hurt again. The run turned out to be an amazing experience. I made some of the closest friendships I’ve made in Chicago. And we had the unexpected excitement of performing for Stephen Sondheim himself at one of our final performances.

As an Alexander teacher, I prided myself on my ability to sit in any chair. But my experience with Follies showed me that there are certain circumstances where I don’t want to have to fight my furniture while doing my job. Playing a show eight times a week is tiring enough without having to compensate for a terrible chair.

I’ve now played three shows at Chicago Shakespeare Theater and have a new way of setting up my station. By stacking two of the theater’s chairs, you get extra-height, the seat becomes level, and the back doesn’t push back as much when you lean against it. Tape the legs together and the chair is secure for the rest of the run. It’s even better than my Stefan chair. I don’t know what chair will greet me when I get to the Oriental Theater for the first rehearsal of Newsies in little over a week. But I’m no longer worried about being that guy. If they don’t have a chair that will work for me, I’m happy to bring my own.

Archer's Bow and Shortened Hamstrings: More Markers of Occupation

Yesterday I wrote about the markers of occupation, the way our activities can shape our bodies over time. My friend Todd sent me a dramatic example from the military history of the middle ages: a lifetime of drawing the longbow was visible in the long dead bodies of archers.

We can actually identify a longbowman’s skeleton by the damage they have done to their bones; otherwise rare defects show up along the shoulder blades, wrists, and elbows. The act of drawing back hundreds of pounds of force every day, hundreds of times per day, strained ligaments and bones to such an extent that some skeletons even started growing extra bone to compensate. Their devotion to their skill permanently changed their bodies enough that we can still identify them hundreds of years later.

Our modern markers of occupation are quite different from the English archers. We are much more likely to be changed by the extreme sedentariness of our modern work environments.

The solution, of course, is to move more, and so people exercise. As important as exercise is, there’s new research that suggests that sitting all day is so detrimental to our health that all the exercise in the world isn’t enough to undo the damage—if we continue to sit all day.

This point was reinforced by a recent piece by Brook Thomas on stretching. Sitting all day shortens the hamstrings and so people try to stretch them to increase their length. Why does this often have so little effect? Thomas argues that it’s not just that the physical substrate of the muscle needs to be stretched. The nervous system needs to reset its expectations about what is possible:

While working on the Liberated Body Short Hamstrings Guide, I kept coming back to the issue of how the hamstrings function, in some chronically short-hamstringed people, as an emergency brake. This kind of compensatory pattern happens for plenty of reasons, but top among them might be under active deep core musculature, too rigid core musculature (yes, underactive and too rigid can come together), weakened adductors, and more. If these or other key stability structures can’t fully do their job, the hamstrings are at the ready. They sub in for a lack of support elsewhere by battening down the hatches...

If your car were parked on the edge of a cliff and was held there only by its emergency brake, would you release it? Not if you are sane. This is the same decision your nervous system is making when you attempt a forward fold and are stopped prematurely.

To bring about a change in the structure of the musculature, both mind and muscle have to be taken into account. The best way to do this? Change what we do each day.

The way to approach rehabilitating [short hamstrings] would be to move with more normal hamstrings length more frequently. For example: to use a standing desk for all or part of the day, to sit on the floor with our legs outstretched in front of us (if we can accomplish that without rounding our backs, another symptom of short hamstrings), wearing neutral-heeled shoes, and to walk and to take frequent movement breaks, among other things.

The road to rehabilitation would not look like stretching the bejeezus out of your hamstrings at their absolute maximum end range for somewhere in the neighborhood of thirty and ninety seconds per day.

We have to stop dividing our lives between sedentary work and vigorous exercise. Alexander lessons can certainly help us unlearn the unfortunate habits that our work lives encourage. But work also needs to become more dynamic. Most tasks do not actually require us to sit for 8 hours a day. The same problems can be solved and the same projects completed using a variety of positions and actions. Ultimately, if the work environment changes, it will be easier for employees to take responsibility for their own health.

This is starting to happen, but it can be frustratingly slow. My sister recently injured her knees in a fall. After getting reassurance from her doctor that nothing was torn or broken (she received a diagonsis of patellofemoral pain syndrome), we talked about how she could modify her activities to help her heal. We had two priorities: cultivate length in the back to take weight out of her knees, and prevent the kind of distorted, compensatory patterns that creep in to the rest of the body after a knee injury.

She found sitting and standing still to be the hardest activities to maintain. So we talked about her options at work. Could she get up and walk around? To a limited extent, yes. If she perched on a stool with her feet on the floor, her knees would be at a wider angle than when sitting. This might provide some relief. Was there a high desk and stool that she could use to experiment and see? No, that wasn’t possible. Could she find a place to lie on her back for 10 minutes or so every couple of hours? It would help prevent compensatory patterns. No, there was no place that she could lie down.

We both were a little frustrated. My sister’s workplace is very intellectually stimulating, but it’s very physically restrictive. This is the norm in many work environments, not the exception.  At some point, our office places will have to change. The archers of the middle ages had no choice about practicing with the longbow—it was demanded by the king. But we don’t owe such fealty to our employers. We owe our work work. We don’t owe work our health.


 

 

 

 

 

Bottom the Weaver and Weaver's Bottom: Markers of Occupation

When I first moved to Chicago, a flutist friend told me about visiting the chiropractor and seeing an x-ray of her back. Though she had left her flute at home, she was shocked to see that the twist of how she held her flute was visible in the structure of her spine. Tom Myers, the Rolfer and author of Anatomy Trains, writes,

Musicians the world over are among those who deal in intense concentration around an object which cannot change shape. The tendency for the body to shape itself around the solid instrument is very strong in all types of music. So strong in fact, that, during a time when I enjoyed a vogue among London’s orchestral musicians, I could often accurately anticipate the player’s instrument before being told, just on the basis of body posture. The accommodation to the flute, or violin (or guitar or saxophone) was so clear that the instrument could almost be ’seen’ still shaping the body, even when it was in its case.

Musicians aren’t the only ones altered by their vocation. A while ago I read Michael Ondaatje’s novel, Anil’s Ghost, about a forensic anthropologist searching for the remains of victims of the Sri Lankan civil war in the 1980s. In the novel, Ondaatje’s fictional heroine, Anil Tissera, received her education in the United States from a real-life forensic anthropologist, Lawrence Angel. Ondaatje describes what I assume to be true stories about Angel:

Anil had worked with teachers who could take a seven-hundred-year-old skeleton and discover through evidence of physical stress or trauma in those bones what the person’s profession had been. Lawrence Angel, her mentor at the Smithsonian, could, from just the curvature of a spine to the right, recognize a stonemason from Pisa, and from thumb fractures among dead Texans tell that they had spent long evenings gripping the saddle on mechanical barroom bulls. Kenneth Kennedy at Cornell University remembered Angel identifying a trumpet player from the scattered remains in a bus crash. And Kennedy himself, studying a first-millennium mummy of Thebes, discovered marked lines on the flexor ligaments of the phalanges and theorized the man was a scribe, the marks attributed to his constantly holding a stylus.

Ramazzini in his treatise on the diseases of tradesmen had begun it all, talking of metal poisoning among painters. Later the Englishman Thackrah spoke of pelvic deformations among weavers who sat for hours at their looms...

These were the markers of occupation.

Kennedy speculated that “Weaver’s Bottom” gave us Nick Bottom, the Weaver, in Shakespeare’s A Midsummer Night’s Dream—turned into an ass by Puck. Weaver’s bottom is still a diagnosis, called ischial bursitis.

Our careers shape us slowly. An act is repeated and becomes a habit. With enough time, habit affects our health.

We know this. And many of us exercise to combat the sedentariness of our work. But work tends to stay with us during our workouts. I often see runners jog past my studio window. It’s pretty easy to see which runners work at a computer all day. You can still see the office slump: head forward, shoulders rounded, arms up towards the computer that isn’t there. This is not to say that exercise doesn't have many wonderful health benefits. But if, for example, someone has neck or shoulder pain exacerbated by sitting at work all day, they will get limited relief if they unwittingly stay rounded forward on their run.

It can be startling to discover that the contours of an activity have stayed with us, hours after we’ve moved on to something else. And it takes time to reverse the pattern.

I started studying the Alexander Technique right after graduating from conservatory as a violinist. The violin is held on the left, and as I became more aware of my habits at the violin, I began to realize just how much of my life was spent looking to the left. When parallel parking, I would look over my shoulder to the left. When swimming the front crawl, I would breathe only to the left. I would wait for the train—which would be arriving from my right—facing the left. And I fell asleep on my stomach facing left with my left arm raised. It was as if in my sleep, I would still be practicing the violin.

One night I decided to change and lay down on my stomach turned to the right. You would think that this would be a simple matter, but I felt like the mattress itself was pushing up towards me, straining my head to the right. After a minute or so, I gave up and turned back to the left and fell asleep.

But each night I tried again. And each night facing the right became more and more familiar, less and less of a strain. Eventually, it became so comfortable that I began to prefer facing the right. It was a small thing, but a welcome change. Now I know that if I’ve been rehearsing all day or performing at night, I can go home and in at least one little way, undo a mark of being a violinist while I sleep.





 

 

 

That's Right: Nothing is the Solution to "Text Neck."

Recently my Facebook feed has blown up with articles and news segments about the dangers of “text neck.” It turns out that spending hours a day hunched over your smartphone texting is a bad idea and leads to all sorts of neck and upper back issues. Who knew? The news stories have given some good counsel—like limiting the amount of time you spend on your phone and moving your body in ways that are different than hunching over a phone. But as I’ve read the advice about preventing “text neck,” I keep wondering, do we give ourselves any choice in the matter?

I was reminded of a student who came to me for Alexander Technique lessons several years ago, just before the smartphone revolution. He was a doctor complaining of neck pain. He tried to set up regular lessons, but like many doctors, his schedule was not entirely his own. Even when we managed consistent lessons, he was always on call. With most of my students, I ask that they leave their phones off so that we can work without interruption. But he had to leave his pager on, just in case he had to respond to an emergency at the hospital.

I have to admit, he was a challenging student. At the start of each lesson, he would fill me in with a detailed report on his neck symptoms at work. He monitored himself ceaselessly to see if there was any improvement. He was obsessed with finding the “correct way to move” and gave himself detailed instructions using his voluminous knowledge of human anatomy. He would inform me, “I need to tone up through the erector spinae group, widen through the trapezius and release into the quads.” I suggested that he not micro-manage his movements, and told him the parable of the centipede who tried to control all one hundred legs consciously and ceased to be able to walk at all.  I tried to convince him that the first step was to leave himself alone. He needed to practice “non-doing:” it would give him a chance to observe himself and see if he could discover if his movement habits contributed to his neck problem.

One lesson I finally succeeded in getting him to stand quietly, leaving himself alone. I had just placed my hand where his head meets his neck and was helping him experience a “free neck”—moving his head gently back and forth in the “no” direction—when his pager went off. At the sound of the buzzing, his neck tensed dramatically, the back of his head pulled back, and his shoulders went up around his ears.

He duly checked his pager—it was not an emergency. We looked at each other. “I think we know why you have some neck tension,” I said.

‘Push notifications’ inform us not only of texts or phone calls, they alert us to e-mail, Facebook status updates, tweets, breaking news, traffic reports, weather alerts, and the latest available level on Angry Birds Star Wars II. Our response becomes habitual. The alert sounds and we jump into action. If that habit includes pushing our head forward 30 degrees, we may not even notice our necks tense to carry the 40 lbs of functional weight. That’s the thing about habits: they are unconscious and automatic.

The head is a heavy object. The average head weighs about 10 pounds. When your neck is free and the head is poised on a lengthening spine, it has a functional weight of 10 pounds. But for every degree the head is held forward—whether towards a cell phone, a computer, a book, a music stand, or a musical instrument—its functional weight increases dramatically. As this study by Kenneth K. Hansraj found, a 10 pound head held 30 degrees forward has a functional weight of 40 pounds.

So what we do with our heads has an enormous impact on the health of our necks, shoulders and backs. With my doctor student, the anxiety around the insistent and unbidden summons of his pager caused a spasm of tension in his neck, jerking his head back into his spine. The action was particularly dramatic in his Alexander lesson because it happened right after I had helped him find length in the neck and freedom at the head-neck joints. In his everyday life, though, he rarely freed his neck and it became increasingly tense and painful throughout the week.

Smartphones and doctors' pagers are similar in one important respect: they are stimulus response-machines. And smart phones are even more stimulating: "push notifications” inform us not only of texts or phone calls, they alert us to e-mail, Facebook status updates, tweets, breaking news, traffic reports, weather alerts, and the latest available level on Angry Birds Star Wars II. Our response becomes habitual. The alert sounds and we jump into action. If that habit includes pushing our head forward 30 degrees, we may not even notice our necks tense to carry the 40 lbs of functional weight. That’s the thing about habits: they are unconscious and automatic.

But there’s a key difference between doctors' pagers and our smartphones. Doctors are required to have a pager and may even, like my former student, resent its constant thrall. But if you’re anything like me, you love your smartphone. In fact, you could say that the stimulus from within—”I wonder what my friends think of that cat photo I just posted on Facebook,” for example—is as strong as the push notification from without.

Understanding the power of habit is as important in preventing “text neck” as limiting our time on our phones—maybe more so, since so many of us enjoy the time we spend on our phones and don't have any intention of reducing it down. With my doctor student, we practiced a different response to his pager: when it sounded, he would remind himself to pause, take his time in responding, free his neck. We can do the same thing with our phones. The next time it pings, we can give our necks a break. We can take a moment, however fleeting, and do nothing.



 

When a Slump becomes a Slouch: How much should we read into posture?

Kyra studied tae kwon do when she was in college. One day her instructor took her aside and said, “You need to work on your confidence.” Kyra was confused. She didn’t think she had a problem with confidence. If anything she was a pretty cocky 20 year-old. “Why do you think I’m not confident?” she asked. And her instructor said, “You’re always looking down during class.” “Oh!” Kyra laughed, “That’s because I’m a cellist!”

When cellists hold their instrument, the tuning pegs by the scroll tend to rest just behind the cellist’s left ear. To avoid the pegs, some will push their heads forward and look down. There are other reasons for this habit: if you look down, you can see your fingers and watch your bow’s contact point with the string.

Not every cellist has this pattern. And it’s not a great habit to have (you can have neck and shoulder issues from the weight of the head going forward). Regardless, Kyra had developed the habit of looking down while studying the cello. It didn’t mean she was insecure.

I made a similar mistake to Kyra’s tae kwon do instructor this summer. I taught the Alexander Technique at the Music in the Mountains Festival Conservatory to high school and college age musicians. We met in a group class in the mornings and students could also sign up for private Alexander lessons on a volunteer basis in the afternoons. In the first class, a couple students struck me as especially slouchy. They seemed wary and rarely smiled. I silently discounted them, figuring that they wouldn’t get much from the class.

We tend to read a lot into body language. A person who slumps in a chair is a slouch: lazy, disinterested, maybe even dumb. A person who looks down is shy or diffident. A person who sits up straight is confident and interested. But maybe it’s a little more complicated than that.

I was completely wrong. Over the course of the two weeks, they became by far the most interested in the Alexander class. They signed up for the most private lessons. They were the most eager to apply what they were learning to their instruments. As I got to know them, I discovered that they were not only keenly intelligent, but talented in a number of areas outside of music.

Of course, these were student musicians at a classical music summer festival, so I shouldn’t have been surprised to find that they were smart and talented. I ended up being a little appalled by how quickly I had judged them based on their posture. As we worked together, I started to realize how much they didn’t want to be stuck in a slump. They were eager to change.

We tend to read a lot into body language. A person who slumps in a chair is a slouch: lazy, disinterested, maybe even dumb. A person who looks down is shy or diffident. A person who sits up straight is confident and interested. But maybe it’s a little more complicated than that.

Earlier this week I told stories about a 5 year-old and an 8 year-old in music lessons. In both cases, a lucky bit of instruction helped them find more poise at their instruments in a matter of moments. But they were both young children. At a certain age—and it certainly varies with each child—patterns become more locked in the body. Then it takes more time to help students overcome the dictates of their habits.

There is a real danger to see the locking in of those patterns as a failure of character, when so often it is the result of forces outside the child’s control. As teachers, it is incumbent upon us to empower our students to take responsibility for themselves—literally, the ability to respond differently, whether it’s looking up and out in tae kwon do class or finding poise at their instrument. But in helping them take responsibility we shouldn’t judge them for their patterns. All too often, our children’s habits are but a shadow of the environments we have built for them.


Distractible, Tired & Slouching: The Wondrous Effects of Sitting All Day at School

I’ve been writing this week about how music teachers can help their students find poise without resorting to nagging them about their posture. Music teachers often bring a great deal of ingenuity to teaching technique and musicianship, but then resort to simple exhortations like “sit up straight” or “stand tall” when teaching poise. From my work as an Alexander Technique teacher, I’ve learned that poise is a subject just as worthy of creative study as, say, vibrato in string technique.

As much as I enjoy giving this advice, it's a little unfair. After all, music teachers don’t teach in a vacuum. If their students show up distractible, tired and slouching to their lessons, it’s not the fault of their music teacher. Their students could just be sitting all day in school.

Two recent posts brought home to me the extent of the challenge. The first was a piece in the Washington Post by Angela Hanson, a pediatric occupational therapist. She wrote about her work with children with attentional issues in school. She argues that children require a minimum of outdoor play—unencumbered movement—in order to develop attentional control.

She describes working with a 6 year-old boy who was struggling to connect with his peers and pay attention in school. He attended her TimberNook camp over the summer, which gives children a week of immersion in the woods.

In the beginning of the week, he consistently pursued total control over his play experiences with peers. He was also very anxious about trying new things, had trouble playing independently, and had multiple sensory issues.

Amazingly, by the end of the week, he started to let go of this need to control all social situations. He also started tolerating and asking to go barefoot, made new friends, and became less anxious with new experiences. The changes were really quite remarkable. All he needed was time and practice to play with peers in the woods—in order to foster his emotional, physical, and social development.

When Hanson met with the boy’s teachers at the start of the fall, she told them that he needed an hour of recess a day at minimum. The teachers were sympathetic, but they told her that the maximum they could do was 15 minutes a day. Curricular demands—especially preparing for standardized tests—made that amount of recess time impossible. For a 6 year-old.

The second piece was published on Grant Wiggins’ blog. An anonymous teacher wrote about her experience shadowing two students at her high school—first a 10th grade student and then a 12th grade student. This was her first takeaway after two days of being a student at her high school:

Students sit all day, and sitting is exhausting.

I could not believe how tired I was after the first day... In every class for four long blocks, the expectation was for us to come in, take our seats, and sit down for the duration of the time. By the end of the day, I could not stop yawning and I was desperate to move or stretch. I couldn’t believe how alert my host student was, because it took a lot of conscious effort for me not to get up and start doing jumping jacks in the middle of Science just to keep my mind and body from slipping into oblivion after so many hours of sitting passively.

I was drained, and not in a good, long, productive-day kind of way. No, it was that icky, lethargic tired feeling. I had planned to go back to my office and jot down some initial notes on the day, but I was so drained I couldn’t do anything that involved mental effort (so instead I watched TV) and I was in bed by 8:30.

Of course, we know that students sit all day and that sitting is tiring, but after years of standing in front of a class—lecturing, able to move around—this teacher had forgotten. And lest we put all the blame on American public schools, this teacher taught at a private school overseas.

In case these two pieces don’t depress you enough, what does sitting all day do to the back? The old adage, “If you don’t use it, you lose it,” applies to the coordination of the back as much as anything. Sitting weakens the back. The c-curve slump that chairs and desks encourage becomes locked into place, as connective tissue hardens to support the collapsed posture. Many students appear to grow into their chairs: you can still see the shape of the chair in their back when they stand up. After years of sitting, they can’t “sit up straight,” even if saying “sit up straight” was good advice. Their backs are no longer responsive to the command.

Yesterday, I wrote about Kyra teaching a cello lesson to a five year-old. She found a creative way to help her student find poise without saying, “sit up straight!” As I wrote at the end of the post, one of the reasons that her strategy worked was that she was teaching a very young child, who still retained a lot of mobility. She might not have had the same luck teaching an older student. In my Alexander practice, I find that it takes several lessons before teenage and college students—as young as they are—start to rediscover the coordination of their backs.

The regimented sedentariness of many schools is a huge problem. It impacts student learning, creativity and health. Because of this, Alexander Technique and music teachers are natural allies. They can team up to bring more rhyme and reason—not to mention movement and poise—to how we teach our children, both in school and out.

 

 

 

 

 

Part 1: A Problem with Pain: Why I started studying the Alexander Technique

Jorja Fleezanis, from a photo by Greg Helgeson.

This is the first in a six-part series about my experience studying the Alexander Technique for the first time.

I had just graduated from Oberlin and pain was on my mind. I wasn’t injured, but I figured it was just a matter of time.

I’d watched many of my peers take time off from playing because of injury, usually tendonitis. One friend imploded in spectacular fashion. She was having hand problems, yet still practiced 7 to 9 hours a day. Her doctor father sent her prescription codeine so she could practice through the pain. The day came when she couldn’t play any more and she realized she would have to rehabilitate her hands. She did start to recover, but at a certain point she felt she’d lost too much time, and gave up her aspirations to perform.

I took it as a cautionary tale. If I felt a twinge in the practice room, I would go home for the day. I was supposed to be practicing 4 to 6 hours a day, but if I felt discomfort after 45 minutes, I would pack it in.

As a result, I was never injured, but discomfort was pretty constant—and often mysterious. Before my junior recital, I had some spasms in the muscles beneath my shoulder blades. What was that all about? One winter term I took a contact improv class (because: Oberlin) and at the start of class we would stretch for an hour. As I stretched, I would feel the tightness in my wrists slowly unfurl. After class I would go practice for a few hours and the next morning the tightness in my wrists would be back.

I may not have had a pain problem, but I definitely had a problem with pain. If I hurt, I didn’t know why I hurt, or what I could do about it. A life in music seemed to mean accepting a life with a certain amount of pain.

That fall I moved to Minneapolis to study with Jorja Fleezanis, then concertmaster of the Minnesota Orchestra. A question dominated my mind: how can I practice enough to be a professional musician and not get injured?

I may not have had a pain problem, but I definitely had a problem with pain. If I hurt, I didn’t know why I hurt, or what I could do about it. A life in music seemed to mean accepting a life with a certain amount of pain.

The question became even more urgent when I started watching the Minnesota Orchestra play. Jorja was generous with tickets to see the orchestra. I had seen orchestras perform before, but I had never seen an orchestra perform every week. I was staggered by the amount of rep they tore through, not only a new program each week, but a new and challenging program every week. It was physically and mentally demanding beyond anything I had experienced as a student.

Jorja was always taking her students out for dinner after concerts. One night, I finally asked: how are you not in pain? How do you avoid injury? Do you stretch? Yoga? Massage? What?

She said that she had studied the Alexander Technique for six years and that she had learned to sit and to move in ways that didn’t wear on her body. I have a memory of her standing in the restaurant and putting her hands on her hips and talking about finding the connection from the back to the hips to the chair when she played.

It’s hard to overstate the influence of a trusted teacher. I’ve sometimes thought that if Jorja had said she avoided injury by bungee jumping I would have grabbed a cord and leapt off the nearest bridge. That winter, when I came back to Minneapolis after the holiday break, I decided to find a teacher. I was fortunate to find Carol McCullough. I remember our first conversation. “I’m a violist,” she told me. “There’s a lot I can show you.”

This isn’t the time to go into all the insights I gained from my first lessons with Carol. But I often reflect about my early beliefs on being a musician and the inevitability of injury. I think many musicians share the kind of pain problem I had as a conservatory student: they defer a true commitment to the work it takes to be a performer out of fear of injury. Through those first Alexander lessons, I was able to put that fear to rest. Carol showed me a way of working that both reduced the risk of injury and renewed my joy in playing. It’s a way of working that is available to anyone.

Next: Off the Map, in which I discover I have no idea where I am in a very fundamental way.

Your chair's Killing You, Now What?: Galen Cranz on 99% Invisible

Galen Cranz was on last week’s episode of 99% Invisible, the radio show/podcast about design with Roman Mars. Cranz is a professor of architecture at Berkeley and a leading proponent of body conscious design, the idea that designers should spend at least as much time adapting things to us as expecting us to adapt to things. Cranz published The Chair, Rethinking Culture, Body and Design in 1998. She’s also a certified Alexander Technique teacher—and a highly esteemed one. She was a featured speaker at the 2013 annual conference of the American Society for the Alexander Technique here in Chicago.

I was excited that she was going to be on the podcast and the episode is worth a listen—you can find it here. It traces out the argument that Galen makes in The Chair. She explains that In the 20th century, we transitioned from an agricultural to a manufacturing to a service economy. The chair became the dominant object in our lives as sedentary work, done mostly while sitting, took over manual labor. But chairs weren’t designed to fit our bodies. People started to suffer from back pain and repetitive strain injuries, which inspired the development of highly adjustable, ergonomic chairs, like the Herman Miller Aeron chairs. Even with highly-engineered furniture, the health effects of sitting all day are still terrible. “Sitting is the new smoking,” and all the exercise in the world won’t make up for sitting eight or more hours a day.

So what’s the solution? Producer Avery Trufelman goes to Cranz’s house and marvels at her collection of mis-matched furniture. She applauds Cranz’s “gusto” at bucking the conventions of normal sitting.

When she’s out in public and gets tired, Cranz opts to kneel, or squat, or lie down. “I lay down in a bank and someone asked me if I was having a heart attack,” Cranz says. “I understand. But I said no, I’m fine, I’m resting because the line is so long!”

Cranz advises against using back support—it weakens the back—and suggests using stools to perch on and lounge chairs to recline. The solution, she says is variety—“The next posture is the best posture.” And Roman Mars intones, tongue-a-bit-in-cheek, “We don’t need fewer chairs. We need more. Bring us chairs. All of the chairs!”

99% Invisible is great radio—like Radiolab or This American Life. But I felt like this episode ended having made only half of Cranz’s point. Great design will only take you so far. Health and well-being require education. As she writes in The Chair, “We need better objects and we need to take responsibility for how we use ourselves while using them.”

It’s been my experience that when my students come to their first Alexander lesson complaining of pain from sitting all day, they're not in a condition to take advantage of varied furniture. They’ve lost the ability to sit without back support, or to lie on their backs without puzzling discomfort, let alone squat.

Great design will only take you so far. Health and well-being require education. As she writes in The Chair, ‘We need better objects and we need to take responsibility for how we use ourselves while using them.’

When I was around 21 and still in college—a couple years before I started studying the Alexander Technique—I got into an argument with one of the teachers at a summer music festival. During orchestra rehearsals and concerts, several of us—myself included—were crossing our legs if we weren’t playing for long periods of time. She thought it looked unprofessional and told us to put both feet on the floor. I told her that the chairs were too low for me and that if I didn’t cross my legs, my back would hurt. Crossing my legs was the only thing that kept me from being in pain.

The story embarrasses me now. There was nothing about crossing my legs that was good for my back. In fact, you could argue that crossing your legs is positively bad for your back. But I was used to it. I liked how it felt, and I would fight with my teacher for the right to do it on stage. It was only after I had taken some Alexander lessons that I started to unlearn the habits that were causing my back pain. It was empowering—even if a chair was too low for me, it couldn’t hurt me.

Back in 2010, I went to see Galen Cranz give a talk about The Chair at the Chicago Humanities Festival. Afterwards, I chatted with a man in the audience who had spent the previous few years working on a new chair design for the workplace. He had incorporated all the latest knowledge about healthy human movement, and his design let workers be more dynamic at work. Yet when he tried out a prototype of the design at an office, the workers ended up pushing all the new chairs to the edge of the room after only a week. They went back to their usual chairs. They were used to them.

At the end of The Chair, Galen Cranz describes her ideal work environment. It’s a place where you can work sitting down, perching on a stool, or standing up. You can take a phone call lying on your back. You can squat to reach low files and stretch high to reach the top of shelves. It’s a place for adaptability and movement. The world would be a better place if Galen Cranz was in charge of designing it, and part of the reason is that she knows that people and furniture need to be equally adaptable. We Alexander teachers can help Cranz in her mission by making the Alexander Technique—and the importance of education—100% more visible.