stress – Essential Physical Therapy

April 23, 2020May 4, 2020

Listening to Your Body: Why It’s So Hard!

I wasn’t always an active person. In fact, growing up I was a total bookworm. I hated sports, I was the slowest person in gym class, and I spent most afternoons curled up with a book or watching TV.

In high school I started working out and watching my diet, and it felt really good! I was also getting more attention from classmates, the cool girls and guys who had never noticed me before were striking up conversations and inviting me to hang out. I even joined some sports teams.

Naturally, I became very attached to my great liberator, exercise. How could I not? It made me feel great, bolstered my social life, gave me energy, and all the other merits that we constantly hear about exercise.

But, there was also a dark side to this life changing health decision.

Exercise and Attachment

This last month I have been sick. Not terribly ill, but definitely not able to run and workout like I want to. And I think I have prolonged my illness to some degree by still pushing myself more than I should have. For me, I am so attached to the boost I get from exercise, that when I don’t have that in my life I start to get really down on myself. I have a good base in meditation and mindfulness practice, but I am still human and I still have my attachments. It takes quite a bit of work for me to “take it easy” and “listen to my body.” And how do you even “listen to your body” anyway?

woman feeling exhausted at work — Do I need a break, or should I keep pushing? (hint: you probably need a break!)

I hear it all the time, “listen to your body, if you need to rest, rest.” But then I also hear the opposite, “push yourself, when you are feeling tired, that’s the time to push even harder!” And, to be honest, I mostly end up just following the advice that suits my mood in the moment, but that’s not always the healthiest choice.

For example, in this recent bout of illness, my body was telling me to slow down, nap, drink tea and CHILL. But I hate the feeling of being unproductive, and when I don’t workout I feel that inner child bookworm creeping up. Or rather, I could say that I am attached to the feeling of being productive, and instead of asking how I could console this inner child that is struggling, I am pushing her away.

It doesn’t sound so good when I put it that way. But that’s the reality of it. To really understand how to actually listen to our bodies, we have to first talk about wanting vs attachment.

Getting Past the “Shoulds”

When I am really listening to my body, most of the time I still want to work out. I love the way it makes me feel, the health benefits I get, and the joy of moving my body in the great outdoors. The difference is that I am not attached to working out, because I can tune in and listen to my sensations and trust my intuition. So, if I get signals from my body that I need to rest, nap, take more time to relax, I can listen to that instead of shaming myself out of it. This is the goal, but that takes practice.

The most common way we disregard what our bodies are trying to tell is by shaming ourselves. My favorite guilt trip is, “Wow, you are being so lazy. You had so much you were going to get done today, and you’re just going to nap? How dare you! When everyone else in the world is out there working!”

Pretty mean, huh? If I talked that way to my friends, I probably wouldn’t have any. But it is not uncommon for us to talk to ourselves in this way. How can we allow for that? It stems from attachment, to the way we think we should act, should look, should engage with our world.

In order to be able to connect with our intuition, a.k.a. be able to “listen to my body,” we have to learn how to let go. To let go of the “shoulds” and get back to our sensations in the present moment.

Learning to Let Go: Two Versions of the Self

Letting go is hard. It’s hard because we feel like we are going to fall apart without the things that hold us together. For me, working out on a regular routine is one of those things. Part of me feels that if I skip a week or two of working out, I’m going to be horribly out of shape, feel awful, and be a hypocrite (because a lot of my job as a physical therapist is teaching people about exercise!). This is the part of me I call the Fear Self. But there’s another part of me that knows I’m going to be okay. This second part is what I call the Rational Self. She looks at the big picture, and knows that I will get back to working out when I am better, that by taking a real break I will heal faster and get back to my routine faster. The rational self is rooted in truth and fact instead of fear and worry.

At first, the fear self is always louder. She comes up with all sorts of reasons to be concerned, sad, and frustrated. She is small minded and short term focused.

The rational self is quieter, she’s always there but needs to be called upon to speak up. By seeing the long term results and the reality of the situation, she can make good decisions without being influenced by self imposed “shoulds.”

How To Quiet the Fear Self

To connect with your rational self means to listen to your body, in a real and non-superficial way. In order to do this, we need to first identify our fear self. By naming our fears and worries, we can clearly see how irrational and unhelpful they are. The next time you find yourself criticizing yourself, acknowledge that this is the Fear Self. Tell her that you see her, and you appreciate her concern for you, but you’ve got this one under control.

Here’s an example:

Fear self: “You are not even sick, you are just being lazy. You have all this time to be working on projects and getting fit and you’re not using it! You’ll never get this opportunity again!” (hint: all-or-nothing words like “never” are a clear sign that the fear self is talking).

Me: “Okay, I see you, Fear Self. Thank you for looking out for me, but I am doing what is best for me right now.”

It doesn’t help to get mad at or blame your Fear Self. That will just have the opposite effect. Instead, think of your Fear Self as a scared child, who needs comforting and consolation, not to be yelled at or scolded.

*Remember: listening to your body starts with being kind to yourself.

Of course, you won’t be able to catch every critical comment, but whenever you are able to go through the process of calling out the Fear Self, you are developing new neural connections that make it easier to do the next time. It is a skill to cultivate and hone.

Once you’ve identified the fear self, she loses her power. Just by naming it, you begin to see the fears and worries for what they are: intangible ways of keeping us stagnant in our old patterns. To move forward, to grow and expand as a human being, we need to connect with the rational self.

How to Connect with the Rational Self

Once the fear self is quiet, the rational self can emerge. Let’s stick with the example above.

Fear self: “You are not even sick, you are just being lazy. You have all this time to be working on projects and getting fit and you’re not using it! You’ll never get this opportunity again!” (hint, all-or-nothing words like “never” are a clear sign that the fear self is talking.

Me: “Okay, I see you, Fear Self. Thank you for looking out for me, but I am doing what is best for me right now.”

Connecting with your rational self and listening to your body

From this point, I can ask the Rational Self, “what do I really need to do right now? Am I being lazy, or am I actually sick?” Then I focus on the area of my belly or chest, and wait until I get an answer. This also takes some practice, but really it doesn’t work if you over think it. Just ask, focus on the center of your chest, and see what comes up. For me, the answer way, “Girl, you are actually sick! Rest up!” And when I heard that my thought was, “Duh! How have I been ignoring this obvious advice?”

The harder part is actually listening to that advice. And I promise you, if you continue to not listen, your body will make you listen. In the past, I’ve pushed myself to the point where I HAD to lay in bed for a while. That is my old pattern, to keep pushing and ignore those signals to slow down. I’m not perfect, that’s for sure, and it takes effort for me to change this pattern. Of course, doing the things the way we’ve always done them is easier. It’s an inertia, you’ll keep going the way you were always going unless some effort is applied in another direction.

So, as for me, I’m still working on taking it easy, and listening to those signals from my body. Sometimes I don’t want to listen, and I give in to the Fear Self. But I keep trying, and I’m getting better.

With all the latest diets, pain “cures” and workouts at our finger tips, it can be really hard to decide what works for you and what doesn’t. But the more you can connect with your Rational Self, your True Self, the easier you will be able to navigate decisions about what is best for you.

Have you ever struggled with the Fear Self, or had trouble listening to your body? I’d love to hear your story. Share your story by leaving a comments below.

May you find ease in your body.

Derya

April 21, 2020April 22, 2020

Whiplash, Pain, and the Brain.

Earlier this week it snowed a lot. Then it melted, and froze overnight. And when I took my dog out for her morning walk, well, you can probably guess what happened. I didn’t make it 20 feet from my door before my feet slid out from under me on a patch of ice and I landed hard on my butt, with my head being painfully snapped back. I was, of course, a little stunned and went back to my house to survey the damage. No broken bones, just some bruises. Over the next few days I monitored myself for signs of concussion, which , thankfully, there were none, but what I did have was a painful stiffness and ache in my neck when I tried to move my head. “Oh great,” I thought. Whiplash.

When I first walked into my house after slipping on the ice, these were the thoughts in my head, “oh no, you have a delicate neck. This is going to be so bad. You are going to be dealing with this for months. What if you have another concussion? That’s going to really mess you up…” and on and on.

Luckily, I had the knowledge and training to know that these thoughts would be the most significant factor in my speed and completeness of my recovery. Even though it was hard, I started to change my self talk. I said to myself, “this is not that bad. You’ll get over it soon with a couple days for your strained muscles to heal. You didn’t hit your head, and there are no signs that anything is seriously wrong. You’re going to be ok.”

At first, I didn’t believe these words I told myself, but I kept up with it. And, over the course of the day, I started believing a little bit of it. But more importantly, my body felt less tense and guarded. Now, three days later, my neck pain is almost completely gone. I didn’t have to go to a chiropractor or have needles stuck in my neck. I didn’t have to do any special exercises except some breathing to calm my nervous system. I didn’t even have to change my daily activities and still did what I would usually do, including exercise.

Of course, it’s not always that easy, and it has not always been the case for me to get over neck pain that quickly. I have had many neck injuries of varying severity, and the pain of them has plagued me for many years of my life. I tried everything, acupuncture, chiropractic, and of course several physical therapists. Those all helped, but my neck pain never really went away until I changed the way I thought about my pain. I know, I know, it sounds like I’m saying, “it’s all in your head.” Which is just not true. But, it is true that a lot of it is in how your head and your body talk to each other.

Pain and the Brain

You see, the brain determines levels of threat, and sends signals to our body on what to do accordingly. When your brain perceives high threat, it starts emitting neurotransmitters that tell your body to tense, to breathe more shallowly, and halt healing processes.

This is actually really good. For example, let’s say you’re a wild human and you get attacked by a tiger. You find yourself bleeding and injured, and your brain knows that it needs to get your muscles tensed and ready to go so that you can hoof it back to your village before you die in the middle of the prairie. (Do tiger’s even live on prairies? Anyway, you get the idea). Your brain, in that moment, is not worried about healing. Healing occurs when you get back to the village and your wounds can be tended, you are safe.

But what if you never get to the village? What if the stress of getting attacked by a tiger is replaced with the stress and worry that’s associated with chronic neck pain, the fear that you will never get better, the threat of having to deal with a stiff neck on top of all the other things you are having to deal with in your life right now?

In this scenario, your body never gets a signal to relax, to soften your tensed muscles, to release a cascade of neurochemical transmitters that promote healing. You become caught in a troublesome feedback loop: your muscles get’s tense, which causes your brain to percieve threat. As a result of that percieved threat, your body get’s more tense. And on and on, until you find yourself dealing with months to years of pain with no one able to explain to you why it won’t go away.

Getting out of the Cycle of Pain

I have been there, in that loop. I have a tendency to go back there, maybe it’s just how I’m wired. I have to actively, consciously, change the way I think about my body and pain in order to subvert that loop. And it works. I also use relaxation techniques and mindfulness meditation practices to assist me in this process. But what has been so fascinating to me is that this is the missing link in healing from chronic pain, and, perhaps more importantly, preventing it in the first place.

This is not news to the medical community; there have been plenty of studies linking a patient’s outlook on recovery to how well they actually recover. This mind body connection is starting to become more popular in pain management, but in most cases it is not emphasized or even acknowledged in our healthcare system. Certainly, there are appropriate times to seek invasive modalities or even surgery, but shouldn’t we start with an intervention that is very low risk and potentially very high reward in regards to resolution of symptoms?

I have created some resources to help you manage your pain and to prevent yourself from developing chronic pain syndromes. It starts with being able to sense and feel your body, in a non-threatening way. This will allow your brain and body to get out of the cycle of threat and pain and back into fluid, alternating, reciprocating motion.

Getting Back in Your Body

A great place to start getting back in your body is with this simple 5 minute Guided Body Awareness Technique. (You should try it, it’s really relaxing!)

Five Minute Body Awareness Exercise.

Remember, pain is not just in your body, and it’s not just in your brain. Whoever says that mind and body are two separate things is just wrong. You can’t treat one and not the other and expect to change the patterns that we live in. If you find yourself in chronic pain, be kind and gentle with yourself. Reconnecting with the sensations in your body is the first step to letting go of these stuck patterns.

May you find ease in your body.

– Dr. Derya

April 16, 2020August 19, 2020

How do I Release Tension From My Body? 3 Quick And Easy Ways to Relax

It was my second year of physical therapy school, and I was sitting in the white and beige lecture hall. The room emulated the newness and grandeur of the medical campus, but lacked character or color. The course title, “Musculoskeletal 101,” was stamped in the top right of the slides, and today’s topic was Managing Dysfunction of the Cervical Spine. I was bent awkwardly over my desk, furiously taking notes when I had to take a break because my neck was just killing me.

The irony of this was not lost on me.

Even though in physical therapy school I was learning about all the cool ways to crack joints and push and pull on muscles, the tension in my neck was inescapable. I was seeing a physical therapist myself, who would stick needles in my ropey neck tissue, and I was spending my precious study time rolling all around on tennis balls and stretching in all the right directions to “loosen up” my neck. While these things helped for a short while (and some not at all)

I couldn’t help wondering if there was another reason I was getting so tense.

Did I mention that physical therapy school is one of the most stressful things I have ever done in my life? Long commutes, sleep deprivation, assignments that took longer than the hours I had to finish them, projects and social dynamics, constant testing, hours of note taking, clinical rotations with high expectations… you get the picture. I don’t regret any of it, it was an invaluable experience. But I DO regret not having the tools to help me manage my stress levels, because it was taking a huge toll on my body.

Why Do We Get Tense?

We tense our bodies as a way to protect ourselves. It just so happens that high stress levels cause your body to perceive threat and therefore seek protection. Another reason we get tense in our necks, lower backs and hips is to hold ourselves up when our core is not functioning well. Guess what? Stress triggers us to shunt blood away from our core and to our arms and legs (because if there’s a threat, you better be ready to run!)

This is what I call the stress-tension one-two punch.

It’s the double whammy that stress has on causing tension in our bodies. The first blow is the initial tension you get directly from the stress hormones in your body that are readying you to fight or flee. The second comes from the compensatory way your body carries itself when in a stress state.

Hold on a sec! My stressful scenario wasn’t one where I had to fight or flee, I was just bent over my computer hacking away at a keyboard like a madwoman on a diet of coffee and energy bars. Why would my body have to ready itself for anything?

Tension and Stress

The thing is that your body doesn’t know the difference between the stress of being chased by a mountain lion or the stress of your boss adding an extra pile of work to your already overflowing inbox.

Stress is stress! The same hormones are released, and the same responses occur.

Our systems to manage stress are a primal instinct, present since we were “wild humans,” if you will, and the threat of having to fight or flee for your life was a more common occurrence. The steady drip of minor stressors (emails, traffic, alarm clocks, board meetings) did not even exist yet.

We are designed to manage a stressor that is an immediate threat – it is something that we deal with and then it’s over.

You either get away from the saber toothed tiger chasing you down, or you kill it, or you die. Done. Your system takes a few minutes to an hour to return to relaxed muscles, deeper breathing, and an active core. You can rest, digest, and hold yourself up properly.

When we have that steady drip of stress, however, our body doesn’t know how to get back to that baseline “rest and digest” state anymore.

We’re constantly juiced with stress hormones that make our body tense, despite how many physical therapists or chiropractors poke our muscles or push on our backs. To get rid of that tension, we have to get to the source.

We have to help our nervous system relax.

A Nervous System Reset

Even though we can’t always change the world around us, we can certainly change ourselves. You may not be able to change your work situation, your commute, or your other stressors.

But you CAN take small actions that reprogram your nervous system to quickly get back to that place of calm, and by doing so let go of tension in your body.

There are lots of ways to reset your nervous system. Below are three of my favorites because they are:

Easy to do
Fast
Effective

One way is by balancing the right and left sides of the body with your breath.

Balancing Breath:

sit comfortably. Bring your right hand index and middle fingers down, leaving the right thumb, ring and small fingers up (see video below if this is tricky for you!)
Cover your right nostril with your thumb, and exhale completely through your left nostril.
Pause for a 4 count, then inhale through your left nostril.
Cover your left nostril with your ring finger, pause for a 4 count, then exhale completely through the right nostril.
Pause for a 4 count, then inhale through the right nostril.
Pause for a 4 count, then cover the right nostril with your right thumb and exhale completely through the left nostril.
Continue with this sequence for about 6 breath cycles. Then rest.
Do this 1-2x/day.

Alternate Nostril Breath: a simple way to balance the body

Notice how you feel before and after doing this exercise. With some practice you can do this quickly and easily to help your body relax and release tension.

Cupping the Eyes

Did you know that how you see the world affects how tense your body gets? No wonder most people who work at a computer all day develop back or neck pain (or both)!

By letting our eyes relax, our nervous system gets an immediate signal that we are safe, and our bodies relax as a result.

Here’s how to do it:

Lean your elbows on a desk or table. Place your head in your hands so that the perimeter of your palm rests on the orbit (boney part around the eye). You don’t want any pressure directly on your eye.
Close your eyes, and stare into the darkness behind your eyes.
Try to make your field of vision very wide, like you are trying to take in as much of the view behind your eyes as possible.
Notice the gradations of light behind your eyelids. You will notice that it is not all black, but rather that there are different grades of blackness and lightness.
Focus on the darkest areas, see if they get bigger.
Tip: if you don’t notice any different gradation of blackness, just keep focusing on the wide view behind your eyelids.
Stay for 2-5 minutes, then come back by lifting your head and slowly opening your eyes.
Do this 1-2x/day.

How to do it: Cupping the Eyes to Help your Body Relax

Notice how you feel after. Try to connect with and remember in that feeling of relaxation in your body.

Breathe!

When we are stressed, our breathing becomes shallow and rapid. Chances are, if you’ve been stressed for a while, you haven’t taken a full breath in a looooong time. And when I say a full breath, I don’t mean getting a lot of air in, I mean getting air OUT!

That’s right, when we are breathing shallowly, it’s the lack of complete exhales that prevents us from getting new, oxygen rich air to our brain and other tissues. If you can’t get the old stuff out, you can’t make space for something new (that’s a good metaphor for life, too)!

Here’s how to do it:

Sit comfortably.
Place one hand on your lower front ribs.
Inhale quietly through your nose.
Exhale completely through your mouth, making an “ahhhhh” sound.
Pause 1-3 seconds at the bottom of your exhale before inhaling again quietly through your nose.
Repeat 4 breaths. Rest and repeat 4 more cycles of 4 breaths.
Do this 1-2x/day.

Like I said, I wish I had known these ways to de-stress when I was in physical therapy school. I knew stress mattered, but I didn’t realize the incredible impact it was having on my body!

I hope this article prevents you from having to endure chronic tension in your body, and from having to constantly seek ways to release tension. If you can find the wellspring of calm and ease within, the body will follow.