Ok ok ok. I'm back again - and for the second time this week? 'Ohh Nooo!', I hear you say....
'But Here's The Thing' (to quote a popular if Cheesy expression nowadays). On a slightly more Reflective Note than usual, here goes:
Many of Us PMR / GCA Lot here talk not only about the Medical, Technical and Clinical aspects of our Health Conditions and the Myriad of possible Remedies: but (as important?) how can we best Cope physically and / or psychologically / emotionally on our often tortuous Journey?
This reminds me of about 20 (!) years ago pre-PMR when, as a much younger, very fit, strong and active 'Action Man' I played Squash competitively, pulled trees out of the ground single-handed and did many other such Heroic things for better or worse (often, worse).
At the same time, I regularly suffered from lower-back problems including herniated ('slipped') disks (T4/5) that often immobilised me for weeks on-end. What, Me - at the tender age of only 40-ish?! The often self-inflicted back pain was Excrutiating, and Scary. At one time I thought 'This is IT - I'm doomed to being semi-crippled for ever'. And, at that time and on reflection, Stress was also a contributing factor. Hindsight can be a great Learning Experience..
After a recommendation from a friend to explore the Alexander Technique (and despite my scepticism about such supposedly Holistic things), I took the plunge and went along for my first 'Lesson' in AT.
In short: the Outcome was a Revelation. First, my AT Teacher explained the Principles of how Mind and Body often interact physiologically (and the associated mechanical problems in terms of the probable impact of emotional or habitual Stress - and its impact on physical health in my case).
Then, she simply invited me to 'Sit in this chair and then stand-up'. "Ok", I replied, with more doubt than confidence in the process.
So, I sat down in the comfy chair - and then sprang-out of it like a Whippet emerging from its trap at a Competitive Race Meeting (as is my usual style). I thought: 'That's it - I can get out of a chair: so what's the problem?!'.
My lovely AT Mentor smiled knowingly and said:
"Mark, your Mind is 'End-Gaining' and racing ahead of your Body's ability to keep-up. Getting out of a chair isn't a Race. It only takes a couple more seconds to do it smoothly and gracefully - and it can save precious physical energy too. What's going on 'In There' (i.e. your Mind) when you are so Hasty and potentially Physiologically / Mentally Stressed / Not Relaxed about even simply arising from a chair? How about trying to 'roll' forwards elegantly out of the chair in a smoother, more physiologically efficient way? Take a few seconds longer, and try to do it with less effort".
I tried it - and it immediately confirmed the Value of the Alexander Technique for me, at least. I became an AT Disciple from that day onwards. And 20 years later, (and despite getting older and sometimes struggling with the physical challenges of PMR), I still keep-in mind the AT Principles of 'Ease and Efficiency of Physical Mobility' and not to mentally 'End Gain' / or un-necessarily strain myself mentally or physically. And: I have few if any lower back problems even though I do nearly as much physically as 20 years ago.
My Conclusion?
Although the Alexander Technique (or any of its equivalents) won't fix the physical symptoms of PMR, its Principles might at least help some of Us Lot to cope better with them by employing a 'Mind AND Body' approach from day to day.
Ok, that's it. I hope this has been thought-provoking and might just help a few of Us Lot on the PMR / GCA Journey.
Best Wishes
'Uncle' MB
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markbenjamin57
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Thank you for the post. I think I may try the Alexander Technique. It could be a drug free way to control some of the pain. Stretching does seem to help me but this may be even better. Thanks again.
I have been congratulated on knowing how to sit up from lying in bed and get out of bed correctly - also a major factor in low back pain! Getting out of a car is also a skill to learn if you want to avoid knee problems.
When my PMR first developed, one of the major problems I experienced was 'just getting out of the car' my technique was almost like falling out which was not voluntary, but it worked. Fortunately I didn't have far to fall as it was a sports car at the time. Now the OH has a Evoque which is much easier to 'sort of climb down from' Now things are much improved and being able to raise my legs again, so I am now back to the sports car.
Current update on pred dose. After about two weeks on 2.5mg, I observed stiffness in fingers of left hand on waking up in the morning and slight shoulder pain in right arm in late evening, which incidentally was the first symptom I developed closely followed by not being able to raise my legs.
So I have returned to 3mg via 7mg for one day, 5mg second day and now 3 for last 3 days, and thing have settled down.
I think I am just playing snakes and ladders at the moment. but I will stay at 3mg (if that works) now for at least a month and try again then.
Thank you for posting this Mark. The Alexander technique has popped in and out of my life over the years and yet I never succumbed to its attractions. I went through a period of having to do a lot of public speaking at work, each and every time petrified me, it was at that desperate stage that I contemplated having command over my body and conveying confidence and mastery over my subject. Here it is again! I have been thinking, just how inelegantly I move, how my walk feels like a spraddle sometimes, how I descend the stairs like an ancient lady, often accompanied by a blood curdling scream when my knee gives painfully away. Moving mindfully with good posture might help everything, and the years would appear to drop off maybe. Thanks for posting. Could be part of the “repair the damage stage”.
Jane, I only had a couple of sessions but it really educated (re-educated?) me about good posture and movement / alignment - all about HOW we move, sit, lift etc. The AT 'Mind / Body' approach is fascinating - also Frederick Alexander's personal story. I'm sure knowing the principles of AT can help some of Us Lot in dealing a bit better with PMR stiffness at least.
I've read that infants have naturally good posture and movement, but we tend to un-learn this as adults due to the 'End-gaining' factor, physiological / mental Stress and bad postural habits etc. Food for thought..?
Know what you mean about public speaking and fear! I used to run a lot of Presentation Skills training courses, and one of the most frequent Participant 'Needs' was just that - how to cope with Stage Fright and feel in control of the subject / audience / presentation etc. All in the Mind.. ?
Why am I not surprised by your final paragraph at all. I used to get good feedback, about being calm, inclusive and warm, but I wanted to run away, break a leg, anything in the moments before. Once in Birmingham, there was a small earthquake in the middle of my presentation, I was sure I had conjured it up. I was sooo pleased.
Mindfulness seems similar in some respects to AT, that is a good discipline also.
I think many of us share the same traits perhaps that’s why we are where we are.
My impression of Mindfulness is that it’s a bit like CBT and some of the others that increase positively and relaxation, my problem is that when I stop and lie down I just go to sleep, maybe that’s what I need most, to unplug the Duracell Bunny
I did an Adult Education course in Alexander Technique abut 25 years ago. I agree with everything you say and do still put it int practice when I remember. It's all about posture and keeping the head, back, spine in a straight line. I often lie on a hard floor, 2 books underneath my head, arms sitting gently on my stomach, knees slightly bent, and then I slowly lift one arm at a time to the back of my head as far as I can (keeping arm straight) and try to touch the floor behind my head with my hand, all this time the spine is straight. There are various exercises one can do from this position, with shoulders, back and arms. It is a good stretching exercise. This was one of the first things I learnt at Alexander Technique. However, I do often 'slouch' of the sofa, that's comfy too. To me Alexander Technique makes more sense than Yoga (also done that). Many musicians and actors use A.T. or so I am told.
You just reminded me.. there was a leading expert on Physiology talking about back problems on BBC Radio 4 recently saying that, within reason, any posture is ok so long as it's comfortable, and that there's too much emphasis by Osteopaths and Chiropractors on always keeping a straight back etc. His argument was that, if we strain to stay un-naturally 'straight' all the time, that can be worse than adopting a comfy posture.
And.. he said that there's no evidence to suggest that people with 'poor' posture suffer more with back problems than those with 'good' posture - the body automatically adjusts itself to whatever it feels is best for it in context. His co-contributor on the programme was a Chiropractor and they had a very lively debate about it!
I'm sitting on the fence on this one - but with a straight back of course!
I was once told by a physio that my back problems were entirely my own fault because of bad posture. OTOH - the physio I see here said you adopt the posture that hurts least if you have back problems - exactly the opposite! The physio here actually helps achieve a very low level of pain - the other one simply made it worse...
I think this is probably right. I don't have a straight back and I have never suffered with back problems. I was knocked down by a car 22 years ago - he was coming out of a car park, slowly, but was only looking one way, he hit me twice, first time I was still standing, he still hadn't seen me, so he accelerated and I went up the bonnet - he saw me through the windscreen, slammed on his brake and I shot off falling on my back, OUCH!! Miraculously nothing was broken, but my muscles and ligaments were all pushed sideways. Six months later all was well, and I never had a back problem since, that is until PMR reared it's ugly head. I think it's the genes - not PMR - strong bones. However, good posture (mine isn't) keeps one breathing properly, helps with digestion, etc.
OUCH too...! I'm sure you're right. Maybe a conspiracy of Genetics, Circumstances and a bit of Bad Luck too? And, as you say, the likes of PMR and similar illnesses will probably further expose these contextual fragilities.
It's all very well for some Physiotherapists / Chiropractors / Osteopaths etc to apply a blanket approach to postural 'Wellness'. But how many of them have experienced PMR and all of its 'quirks'?
I agree: the main thing is KEEP BREATHING (essential?). Eating well helps too!
Whippet out of a trap, yes that’s me. I read this after I had rolled inelegantly out of bed. Sheffield Jane’s description also fits me exactly, other than the public speaking, too much of a show off to be nervous.
I especially relate to the stairs with the blood curdling audible accompament. My daughter always says I am better when I behave like a floating fairy, no rushing gentle pace.
Going to drift slowly downstairs and get my breakfast then read more about AT 🥂
Thank you Mark,l,shall try and be more aware of how l move around and take my time .l am not surprised that you suffered back pain after pulling trees out of the ground,but l suppose it depends how large the trees were.l find it hard to pull plants out of the garden when the roots are deep and spread out. Thank,s again for your good advice.
Ahh, thought I better check Dr. Google for AT - I thought you meant go out with my PMR and invade most of the world and take on some elephants as I try and defeat India.....
My daughter, who is a piano teacher , has found the Alexander Technique to be invaluable. She was offered it while studying and recommends it to her students.
Sounds like one of the exercises my physio is trying to teach me at the moment but my neck hurts so much I've stopped doing it. Seeing him tomorrow and am having to tell him I can't do it! I have to cross my arms resting my hands on each shoulder and slowly rise from a chair, I think the rolling forward is a good tip, he wants me to remain straight!! I will try your way, thanks Mark. Hurried reply this as in the middle of something and I keep losing my web access...
Mmm.. Telian. He sounds (must be) right in principle (i.e. straightness / alignment etc) but does he know how PMR works physiologically (i.e. not so much about muscles themselves but more about continuous inflammation in the, er, other bits connecting with them)? If not, he might be pushing you a bit too far. Maybe check that out with him? And don't do any movements that are really uncomfortable / don't feel 'right' in your PMR context.
Yep, re. 'rolling out of' a chair: I remember my AT teacher educating me about how Us Humans have evolved to be 'top heavy' bi-peds unlike many other Species - and so most of our body mass / weight is usually in our top-half (Really? - Dugghhh!). And, so, according to the Laws of Physics, we should try to compensate by using our Moment of Inertia to shift body weight and balance more effortlessly when arising from seated without putting un-necessary strain on the bottom half (i.e. lower back, legs etc). I realised I was guilty of this when observed to 'spring' out of the chair! Taller and / or heavier people seem to suffer these problems especially.
It's difficult to explain the 'rolling-out-of a chair / bed / car seat etc..' method anatomically: but I vividly remember my AT teacher making me practise a kind of shifting of my upper torso forwards first, and then using that momentum to help my thighs and lower back do the rest (rather than the other way around). Old habits can be hard to change...
All I can say is, AT worked Wonders for me and I've adopted new movement habits unconsciously when standing-up, lifting, shifting etc. ever since. 20 years later, rarely if ever any lower back problems - despite the limitations of PMR (not to mention being older).
Talking of 'Moments' of Inertia: I'm having one right now so it's probably time to a get stuck in to glass of the Red Stuff
Thank you Mark, I will have a chat with the physio along those lines you suggest. I understand your 'rolling' method, it makes so much sense. I do two core strengthening exercises each morning before I get out of bed (otherwise I'd forget) and they have helped me keep straight throughout my pain. It is the little tips that are the most useful sometimes. I am concerned, not so much worried, that Physio will dismiss what I say. Also I am going to ask him to refer me to Aqua classes at the hospital, to be under supervision as to what I should or shouldn't be doing - this is because I went to a 'normal' Aqua class and boy was it hectic for one solid hour - my neck....the following day though my limbs felt lighter and even though the neck took about a week of pain killers to settle I feel I want to give it a try with the hospital before I go back to the 'normal' class, I shall then be armed with what I can and can't do.
That's really helpful Mark and thank you for taking the time to reply, glad you did it before the red as who knows what you might have been telling me what to do!!
No worry Telian, all part of the service as well as the Silly stuff wot I usually write here.
As for managing pain, stiffness etc. with PMR, with exercise or other interventions: I think the guiding principle is that dis-proportionately much / the wrong type will only come back and bite us in terms of aggravated symptoms or a flare. After all, most types of Physical (or Emotional) Pain - with PMR or not - are usually a pretty reliable warning sign to stop or change what we're doing! But maybe the Aunties will have their opinion too..?
Of course, much of this ultimately comes down to personal Judgement - but hopefully with a bit of informed Knowledge too
Either way, please keep the rest of Us Lot posted on your progress
Red Stuff open, Tedski under Curfew (again). Looking forward to the Friday Feeling...
Sounds as if you need some more work on your core strength first. You shouldn't be involving neck muscles to do that (just tried it off my rather low sofa!) - should be leg and core muscles I would say. And something isn't right with your neck - by my standards anyway!
You're absolutely right, apart from PMR and OA in the shoulders (and upper body, since 2002 had 10 surgeries) I've had two bad whiplash injuries, (not my fault I add!)
This is useful for my physio appointment today. I was supposed to see a lady physio who told me she would assess me in clinic and it maybe necessary to do an MRI to see more clearly what's going on. When I got there she'd passed it to this young man and immediately dismissed the MRI and who's knowledge of PMR is unknown at this point. So I go armed with my advice from here plus I'm the one who knows what I can and can't do.....so watch this space. Many thanks for your help - again.
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Symptoms of PMR similar to some with Parkinsons ?
