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The door opened to the familiar face of Mrs A. She practically fell
into the chair, exclaiming “The leg’s doing really well, but ohh!
my back!” She rubbed the small of her back vigourously, grimacing
all the while.
Mrs A is a very active woman in her late seventies; she runs a
thriving family business. I have been seeing her once or twice a
month for a couple of years, initially for help with her ‘frozen’
shoulder, but latterly for the combination of a tricky back and two
deeply arthritic knees. Our work together helped relieve some of
the pain she felt in activities like standing and walking, and
probably helped postpone more drastic intervention, but recently
the arthritis was getting the better of her, and she decided to
have knee replacement surgery. This surgery is one of the miracles
of modern medicine. Mrs A found, as many people do, that even the
day after the operation, in the midst of considerable pain arising
from the surgery itself, it was clear that the pain specific to the
arthritis had vanished.
But standing or walking aren’t actions for which we only use
our legs, and their knees; when we stand, it’s our whole self
that stands. In standing, the weight of all the parts of our self
must balance over our relatively tiny feet. Just like an accountant
balancing the books, nothing can be left out, we can’t claim
that the books balance ‘except for’ this or that part.
Standing, then, is a conspiracy of the whole body, in which all the
parts co-operate to aim the total weight through the legs, through
the feet, into the floor. If one part changes, other parts must
accommodate. So for Mrs A, the new situation in her leg also made
quite new demands on her back — demands that, in her case,
were not easy to meet. So this was now her request of me: how could
she best continue her recovery from the operation, but also make
use of the opportunity afforded by her ‘bionic’ knee?
Her first words had told me what she felt was ‘wrong’ and where it
was; my next job was to translate from “What’s wrong?” to “What’s
happening?” I asked her to sit forward on the chair, and I began to
explore her back, touching it with my hands. She was arching
strongly at the place she had been rubbing, and I could feel the
work of the tensed muscles. I asked her to roll her pelvis so that
the back of her waist moved backwards, to look downwards, to let
her whole back round. Then I asked her to come back to her normal
sitting posture, and to repeat this rounding and straightening a
few times. As she did, I could feel that these same strongly-tensed
muscles never really let go into the rounding, and were the first
to act as she returned to normal sitting.
What should these, or any, muscles be doing? You could consider the
heart as the paradigmatic muscle; it rhythmically alternates
between contraction and release in order to pump our blood. If it
doesn’t contract or doesn’t release — either way, we have a
problem! This rhythm of the heart is wonderfully regular; other
muscles have a less predictable rhythm, yet the principle is the
same, contraction and release each have their time. For the whole
back to round, all the muscles behind the spine are asked to
release; for the whole back to arch, those same muscles are asked
to contract. Exactly in the place that Mrs A was experiencing her
pain, the constantly tight muscles were no longer part of the
rhythm of the whole. While that may sound like merely poetic
imagery, the results were very practical: whenever she moved her
back, the muscles in front had a fight with the muscles in back,
and that fight hurt.
I asked her to do the movement of rounding her back again, with my
hand behind the small of her back, but to do the movement this time
in order to push the small of her back into my hand. “Do you have a
sense of how much work it takes to do this? Would you notice it if
that were to be a bit different in half an hour?” Although the
amount of work seemed to be entirely natural — our habits
always do — she thought she might notice if it were to
change.
Then I asked her to lie on her back on the low, padded table that I
use for my work. With her legs bent, so that her feet were flat, I
asked her to push with her feet against the table; again, to push
in order to flatten the small of her back into the table. “How much
work is that? Can you feel how readily your lower back arches away
from the table when you stop pushing?” She could, but as before, it
all felt perfectly natural.
I began to explore with my hands: If I put my hands between her
lower back and the table, just supporting the work her muscles
seemed addicted to doing, then waited a breath or two, was there
any change in the tonus, any release of the tightness? I tried this
up and down her back, wherever it was enough lifted from the table
that I could fit my hands in. My strategy was to support what she
was already doing. Gradually, I moved further away from her lower
back, in each place finding out whether I could do this ‘supporting
act’ from the new, more distant part. What could I do with her ribs
that might support arching in the lower back? With her shoulders,
her arms, her neck? Down into the legs? And in each place, what
happened when I eased off the support — did she take up all
the work of arching again?
This is the almost magical crux of the whole thing: she didn’t. By
the end of thirty minutes of this sort of exploration, her lower
back was much flatter against the table. When I asked her to push
with her legs, to feel how much work was necessary now in order to
flatten her lower back, she could clearly feel the difference.
“Why, hardly any! How did you do that?”
“Wrong question,” I said; “how did you do that? Because it
was you who changed what you were doing; my role was just to
give you the sensation of the work you were already doing, and of
how there might be a choice.” I asked her to come up to sitting, to
do the rounding movement from before, pressing her lower back into
my hand. Again, it was easy for her to notice the difference, the
greater ease, the agility of her hips in sitting.
She thought we were finished then. “No, I said, we’re just now
ready for the most important part of the lesson: your homework!” I
asked her to lie down again, and once more to push with her feet in
order to flatten her lower back. “How will you be able to use
exactly this action tomorrow, or the next day, as a way of noticing
the quality of the flattening?” We talked about slowing the
movement down, noticing its progress through the different joints
of her back, noticing the relation to her breathing, and a few
things like that. “Now, if you start to arch your lower back as you
did before, you’ll have something to try. It may not be enough, but
we can build on this; it’s a start.”
It was a start. The ensuing lessons were not a story of uniform
success; life is a bit complex for that. But we had our
breakthroughs, and she had, gradually, more tools with which she
could respond when her back hurt. Each tool, each new possibility
for response, made her less the victim of her pain, and
instead, more and more able to respond to its call.