Spine Mobility

horse-430441_1920In her book, Mindful Spontaneity [1], Ruthy Alon describes the organization of the spine in detail, here I will limit myself to briefly discuss  some ideas about the spine.

As we know, the spine is composed by 24 vertebrae usually divided in 3 areas, 7 cervical, 12 dorsal and 5 lumbar.  The head is directly supported by the small and  very mobile cervical, whereas the pelvis are hanging from the lumbar also very mobile. Most people suffering from back pain usually refer to the lumbar area.  The dorsal vertebrae in the middle provide the attachment points for the ribs forming the thoracic cage.   Beside its structural function the spine also includes a variety of muscles, joints and nerves, what can make back pain excruciating.

When a good intentioned physical instructors or parents tell us to straighten our backs, what is the image of the spine formed in our mind? If we look at pictures of the spine from the side, it is far from straight, it has two pronounced curves.

In reality,  an healthy spine is constantly adjusting when we move around; if the flux of information is free to travel along the spine  a position change in the pelvis is transmitted up to the neck and modify the head position;  changes in the ankles and feet are reflected in the pelvis. The whole body is connected. If the spine is intentionally or unconsciously held in a given position the flow is interrupted and the vertebrae community does not work together.

In such situations some of the vertebrae, usually the cervical or the lumbar have to overcompensate the loss of mobility of other parts of the spine.

Why some parts of the spine suspend their contribution to the community? It is probably not possible to enumerate all the reasons; some can be related to medical conditions , others to habits,  others to psychological conditions.

Thomas Hanna in his book, Body of Life [2], discusses the “red light” reflex as a possible cause of alteration. The general idea is that a body organization having a specific purpose is constantly maintained,  regardless of muting circumstances.  Moshé Feldenkrais discussed the specific organization associated with anxiety, Peter Levine more recently discusses trauma and its relationship with the body.

The vital organs need to be adequately protected in dangerous situation, the thoracic cage protective role is elicited in all these responses. Muscle contraction is useful to protect the vital organs, on the other hand flexibility is loss when muscles are permanently tense.   In the long run, any change in the body has its counterpart in the somatosensory and motor cortex.

The brain needs to experience  again alternatives to give back the freedom to the dorsal vertebrae and a correct range of movement to the other vertebrae. An headstand is a powerful way to change the usual arrangement of the spine, however it can be perceived as dangerous, so it can be difficult to relax unnecessary muscular contractions.

This consideration holds for all the situations perceived as dangerous,  a very important aspect of a successful Feldenkrais lesson is the creation of a safe environment where learning can take place, so each lesson is an unique exploration that needs to be adapted to the person receiving it, staying close to the present range of possibilities and offering alternatives.

[1] Mindful Spontaneity: Lessons in the Feldenkrais Method by Ruthy Alon
[2] Body of Life: Creating New Pathways for Sensory Awareness and Fluid 
Movement by Thomas Hanna

 

On Learning

Library of Babel

“Cela, n’importe qui pourrait le faire, mais les combinaisons que l’on pourrait former ainsi seraient en nombre infini, et le plus grand nombre serait absolument dépourvu d’intérêt. Inventer, cela consiste précisément à ne pas construire les combinaisons inutiles et à construire celles qui sont utiles et qui ne sont qu’une infime minorité. Inventer, c’est discerner, c’est choisir.”

Science et méthode J.H. Poincaré

If we substitute “inventer” with “apprendre” this sentence of Poincaré could be easily applied to organic learning. The major difference being that initially, without previous knowledge, a baby has no way to discern the useful from the useless combinations. She has only few instincts, pain and rewards to guide her  exploration of the world. Her brain nervous system and body are constantly changing in a given environment. Her sensations and feelings will assist a development that is inevitable if no accidents occur. Myelination may not be complete before adolescence or even late adulthood, pruning, disappearance of certain reflexes will all happen independently  of her actions.

Despite this continuous change of the body and brain landscape the baby will learn, discriminating actions allowing to align correctly her eyes from the ones who leads to blurry visions, actions who allow to reach the plastic bees dancing on her cradle from the ones who will send her hand to crash on the side of the cradle, and sometime an unintentional action will produce a rotation of the neck or of the torso; The consistence of the repeated accident will help to adjust the movement and the intention wiring neurons together in her unique individual way till an organized pattern will emerge.

Once the development is complete there is a lot of redundancy in the system and we can see that many adults when hit by stroke maintain many functions intact and can use those as basis for their recovery. In cerebral palsy, such organization had not the time to develop, so what  happens if something went wrong at birth or during the gestation like in cerebral palsy?

Paul Doron Doroftei gives in his beautiful book several examples of living with such a condition.  J.L. Borges description of the books on the shelves in “The Library of Babel” applies perfectly

“This much is already known: for every sensible line of straightforward statement, there are leagues of senseless cacophonies, verbal jumbles and incoherences. “

The Library of Babel,  Jorge Luis Borges (1941) 

Even in cases of modest damages, if learning is: “throwing away useless combinations… to find out sensible lines” the thousands of senseless cacophonies and incoherences, determined by an alteration of muscular tonus, makes neurons wiring completely chaotic.  The normal development is completely altered and an external aid is necessary to extract order from such chaotic arrangement.

One of the most important aspect that Feldenkrais discovered is the ability to quieten the system, being able to redistribute and rebalance the muscular tonus. Only once this has been achieved movements can start to make sense again and correct wiring can take place.

 

 

 

The vagus nerve and the middle ear

In this fantastic interview Stephen Porges talks about his theory. There are many striking points. One in particular regards the role of the modern vagus, the ventral mielinated branch, on the tonus of the middle ear muscles (minute 23).  Lack of tonus can occur as consequence of a stroke, and one of the consequences can be tinnitus and the hypersensitivity to certain sound frequencies. Such hypersensitivity is also common in autistic children and it can be a response to reduced tonus in the middle ear muscles, due to a bad regulation of the vagus. This dysregulation could result from the lack of normal response to other humans, whose origin is still unknown and maybe due to an anomaly in the mirror neurons,   that can generate a continuous feeling of insecurity.

I think that this could be one of the first experimental evidence providing support to the work of Alfred Tomatis and Guy Berard.  Tomatis and Berard theory  are looked as unproven in the best case by the medical establishment, even if there are reported miracles by parents of autistic children, and as scam in other cases. Surprisingly placebo effects in surgical knee operation at reducing pain and other symptoms in  patients suffering from torn knee cartilage do not prevent to continue to intervene in these cases. Not to mention other operations as tendon lengthening, still performed in palsy children to “improve mobility”, without considering addressing the impulse to shorten the muscles coming from the brain that can make the initial relieve provided by the surgery useless after a short time.

Using Feldenkrais  affects the tonus of the muscular systems in many ways, it would be nice to directly measure the tonus of the stapedius after and before a session, certainly we can see changes in the visible tone of the facial muscles.

 

Functional Integration: an exploration

A woman in her late sixties, acute pain in the left shoulder area, right handed.

Supine at the start with her legs bent.

I started trying to feel the level of freedom in the head rotation, the head is held in place strongly.  I reduce the movement to a tiny suggestion. the reaction is non uniform,  sometimes the movement is exaggerated, sometime is resisted.  I notice a variation in the breathing but intermittently intentional movements and change of position.

Mostly left arm and hand, but also right arms, legs with the feet resting only partially on the mat.  The head relaxes slightly and the breath changes, becoming more abdominal. Both shoulders are lift from the mat, I start to feel the right shoulder blade and to exaggerate the lift and to perform small simple movements of the shoulder blade away and nearer the column and toward the head and the feet, I start to feel the weight of the shoulder in my hand and a reduction of the muscular tension, but as soon as I reduce the lift, the muscles contract again.  Slight push travels to the feet with some dampening, all the muscular system  seems overexcited with excessive tension in the whole body. Keep working on the right side, exploring the arm movement and relation with shoulder blade, rib cage.  Again difficulty to quieten the system, I have troubles getting the weight of the arm, If I let it go it is kept, if I try to move I experience an oscillatory behaviour from continuing the movement or resisting it.  I reduce amplitude and speed and things slightly improve, try to have her to resist more and reduce the resistance progressively but again it does not help much.  I decide to try to feel the  lower body, staying on the right side, there is a good flexibility in the right ankle in terms of lateral movements,  the region near the Achilles tendon is contracted and there is little room for movement of the foot, now I understand the issue with the feet not touching the mat properly with the knees bent.  I work around the sole to elicit the gravity reflex.  There is not much change in the muscular tone, maybe I need to be more patient next time.  I move the foot using the lower leg muscles and feel the tonus, try the push pull, dampening still there but improved transmission. I check the hip joint flexibility and it seems quite good, better on the left that on the right, but much less jerky movements and holding on.

Turning on the side, moving like a rolling pin gives a good response, free of jerky responses and the same applies to exploratory movements to verify the ribs mobility.  I think that maybe it is enough as it seems to me that this newly found response is already beneficial, I decide  to stop the lesson at this stage, hopefully it is a better place.

Standing she is not aware of subtle changes that I can notice mostly in the position of the head now less forward.

 

Organization of voluntary movement -1

A voluntary movement is characterized by the intention of performing it and despite it is slower is much less limited and stereotyped than reflex movements; Voluntary movements can be performed to different level of proficiency by different individual and the ability of executing them is clearly influenced by learning.  What do we mean by learning and do we have a recipe to learn effectively?

Very often when we attend a gym course or a swimming class we are instructed to move in a certain way but we can obtain very similar results performing actions that to a trained eye are very different. Voluntary movements are largely dependent on the motor cortex, this is a region of our brain that we can imagine as a dynamic (plastic) map of our body with each part extending accordingly with the functional role of the limb represented (i.e. the thumb is huge compared to the torso) and adjacent region in our body close to each other; a notable exception are the genitalia (close to the feet) and my guess is that this is related to the foetal position where they are actually close together.

A closer look reveals that the border between these regions are not only
dynamic (e.g. remapping of phantom limbs on other parts of the body) but also not so well defined, a stimulation of the map corresponding to the region of the feelers in rats once the feelers were disconnected after few hours started to produce movements in the anterior limb; either the interpretation of this study is not easy it is possible that the face
map also has some connections with the anterior legs and the removal of the link with the feelers can facilitate such connection.

Another aspect that is extremely interesting in a Feldenkrais perspective is that if two similar actions are performed with different forces (e.g. grabbing a ball) some neurons in the motor cortex decrease their discharge with increasing the force, whereas they discharge when fine control is required.

We learn in Feldenkrais classes to do less during the learning process, i.e. reduce the amplitude and force of the movements, Feldenkrais discussed this in term of the Weber-Fechner law, that Stevens modified in 1953, the idea of the law is that reducing the amplitude of the stimulus we can appreciate more subtle differences and hence learn.

The more modern approach seems to implicate that besides the aspects related to the Weber-Fechner law a small movement is qualitatively different from a large movement not only with respect to the increasing our sensitivity and possibility of learning but also in term of the cortex areas activated.

Interestingly this also poses a problem as learning through small/slow movements might not be completely effective to correct the large/fast ones if the areas activated are different but probably the overlap areas are large enough to have an important influence.