Nevertheless, She Persisted (and so did her big toe)

I had every intention of continuing my tome on spinal movement in this next blog post, but I’ve become completely enchanted by an instragram yoga posture challenge I’m participating in. It’s fulfilling a deep need (or a kick in the ass) to explore my asana practice more deeply and write about the process.

I’m taking videos/photos each day and then writing about what I did and what I experienced.

For 84 days!

The theme of the challenge is “works in progress”, which is perfect since we are all such unique works in progress and our movement practices also continue to evolve.

Part of my personal “works in progress” is lifelong education, which I acquire in various ways – like going to grad school, the instagram challenge, or this….

I just completed a 15 hour evidence-based pain science course last weekend.  

One of the things we may run into as we practice movement, including asana, is pain or discomfort in our body.  And, hey, sometimes we just end up with pain even if we aren’t moving or exploring asana.

This sensation of pain is buoyed by fear, stress, a lack of confidence, not sleeping well, relying on the “I’m getting old” thing, or stopping meaningful activities because we’re concerned we might hurt ourselves more.

What we know about the human body is that it can and will adapt.

Anatomically speaking, our tissues can adapt if we “load” them. Loading the tissues simply means you put a tensile force on them. You’ve got to move to make that happen.

When we are in pain we often stop doing what makes, or what we think makes us hurt.

Smart, right?

Well maybe initially for a small amount of time, but evidence-based pain science points to the idea that we actually need to explore that which we think is causing us physical pain and begin to load it (read: move even if there is discomfort OR a body in motion stays in motion/a body at rest stays at rest)

In class I am always cautioning, “If it hurts, stop.” However, maybe I should be saying,

1. “If it hurts, pause and notice.”  

2. “What are you feeling right now – is there a sense of fear, anxiety? Are you concerned you will hurt yourself further?”

3. Can you back off, take a few breaths, and then modify, move slowly and dynamically, do something else for a moment and then come back to the action that is causing you pain/concern/worry with “DOSE” in mind? Do 10 seconds rather than 2 minutes.  Do 3 repetitions rather than 10.
4. “Try holding the muscles around the region isometrically, take a few steps and come back to the area and move it more slightly or differently?”

This is the adaptation thing. We begin to de-sensitize the pain receptors and habituate by actually stimulating the tissues where we are experiencing the sensation of pain.

That’s scary.  I know.  I experience that fear too.

Caution, though, too much too soon may create a flare up. While movement and loading is imperative, too much of it too soon can create a set back where we become even more sensitized to pain, which can then turn into a downward spiral.

“Dose” is super important because who wants to continue trying to move if it feels like everytime we do it just makes us hurt more?

Ultimately, though, we probably aren’t doing more tissue damage if we begin to lean into loading our tissues carefully and judiciously, also looking for fear along the way.

It’s important to recognize that fear is just part of our defense system, but it can also keep us sensitized to pain so that our pain feels bigger and more substantial than it is.

Many people who have lived in a body for a period of time (um, I’m turning 57 really soon so I qualify for this group) run into the fact that they have OA (osteoarthritis) in various joints.

When my students tell me they have a diagnosis of OA I put an empathetic look on my face, but the reality is that most of us traveling around in a body that has been on the earth for a few decades have OA somewhere in our body (fingers, thumbs, big toes, knees, hips, spine)  

OK, back to the instagram challenge….

One of the common places to get OA is at the hallux metatarsal phalangeal joint (our big toe mound region).

Have you seen my feet?  

I love my feet – these amazing feet that have danced across studio floors and stages, run in triathlons, trekked the Himalayas, taken me on two journeys of the John Muir Trail, hold me up in a variety of crazy ass balance postures in yoga, and continue to serve me every single time I stand up and move forward.

But if you’ve seen my feet you know that my hallux metatarsal phalangeal joints have adapted to patterns of movement they’ve been exposed to and are larger than “normal” and often red and inflamed (you can see the bumps at the base of both big toes in this photo).  I’m making an educated guess that each big toe has plenty of inflammation at the “arth”, which means joint, which means I probably have OA at these joints.

My feet adapted to the loads I put them through earlier in my life – dancing, jumping, leaping, and landing in an externally rotated position, wearing shoes that in hindsight were a ridiculous choice, hiking in boots that were way too tight, and more.

Nevertheless, they persisted!

I have pretty chronic discomfort, especially in my right big toe. Although I do foot maintenance almost daily, have changed my gait, and given away about 2 dozen pairs of shoes that squeeze my metatarsals, I understand that foot pain is something I am going to live with.

To work with the chronic pain in my toes, I load my feet and toes. I don’t do “too much too soon” if I have had a flare up, but I do load them even if there is some discomfort. I don’t expect this to reverse the bunions or OA, but I know that not loading my feet is probably going to make things worse over time.

Right now my right big toe is flared up and I am experiencing plantar fasciosis in my right heel. When I saw that the instagram challenge was spending two days on postures where weighted flexion of the toes (sitting on the heels with toes tucked) was required I sort of cringed inside.

Fear and concern arose before I even asked my big toes to do anything. I felt those big toes sort of pull into themselves with a big “UH OH, NO FREAKIN’ WAY!”.

But then I started playing.  

I think that attitude is important….. Explore by playing.  This is what kids do all the time! They adapt and their bodies learn motor control by playing.

Exploration of the body parts that are yammering away at us can be play.  OK, maybe I’m a tad bit masochistic, but I have also come to trust that my body can do all sorts of things, and really, should do all sorts of things even with a modicum of pain and discomfort.

We are really quite capable.  We just need to practice believing that we are capable.

In the video link below (a speeded up version of my exploration/play), you’ll see me work into Pradada Paryankasana, which is only a preparation for today’s pose.  

Sheesh! Today’s instagram challenge pose is just stupid!  That’s my big toe talking.  I’m willing to explore it, and encourage my toe to move in thoughtful and reasonable loading and will be posting my results on instagram today  (#yogaburr).

I knew that my right hallux metatarsal phalangeal joint was going to need to trust me if I wanted to ultimately create the shape I was being asked to create yesterday.

Nevertheless she persisted!

Here are the steps I took:

1. I manually moved my toes into flexion/extension, then my metatarsals, then I circled my toes, then my metatarsal, then I worked on those action at the ankle while I was sitting down (ok, brain, I’ll sit and do it and not ask the feet/ankles to actually bear weight, but to just make some shapes by moving them with my hands)

2. I stretched my toes against a block.  They are in flexion and pushed into the block.

3. I bent my knees while flexing the toes because the full posture requires flexion at the knees and then I prontated and supinated the ankle joint, which put varying pressure through the flexed toes.

4. I did heel raises on the block with a slow lowering of my heel.  That targeted building eccentric loading at the achilles tendon, which is a very good thing. Tendon thickness requires tensile loading in this fashion.

5. I knew the full pose required me to be in toe flexion with ankles in dorsiflexion so I worked on both those actions.

6. Then I sat in vajrasana with my toes flexed.  Notice how I kept my hands on the ground in front of me to keep some of the load in my arms and not entirely on my feet?

7. I abducted and adducted the thigh at the hip joint and the lower leg at the knee while still bearing some of the weight in my arms.

8. Then I sat back on my heels.  What you can’t see is that my right ankle is supinating slightly because of the right big toe.  Is this wrong? Not necessarily. It’s a strategy for me to be able to do the whole pose and information for me to work with outside of this particular posture, which I don’t spend hours or even minutes in everyday. (in other words, I’m not that worried about it because in the big picture, I won’t be spending much time loaded in this particular way)

9. And then you can see me do the whole lean back, externally rotate the arms, and backbend thing.

I list the steps because it’s important to load joints in a way that is thoughtful and sequenced.  I could ask most of my students with foot/toe pain to do the manual manipulations, a small amount of flexion at a block, and/or the heel raises.  I might not ask everyone to do the sitting on the heel thing, but those actions could be modified by bearing weight on one’s butt while sitting in a chair and by changing the “dose” – time in the pose, etc. 

In other words, it’s possible to do many of these loading actions even if we feel worried or it feels like it is going to be too much too soon.

Here’s the important thing…..

I don’t hurt more this morning.  I was able to run a slow short mile and a half  (loading my plantar fascia carefully for rehab) and lift weights.  That tells me that I did not do too much too soon yesterday.  But even if I felt like I had more pain this morning, I could turn that message into “Oh, that’s interesting.  Hmm, maybe I could do less pressure, less reps, more reps with less time in each position,or take more breaks in between loading next time.”

I don’t throw the movement out, I don’t throw the loading actions out, but rather think about how I could modify it, not do as much, do less range of motion, etc.

Listen, I’m not telling you to go load your body and be in pain.  I’m just linking what evidence-based pain science tells us with a story of how I coped with big toe pain while practicing a weird yoga pose! I exposed the big toe mound, and I continue to expose it, to loading so that I can de-sensitize the pain receptors and ultimately feel a lot of confidence in my ability to continue moving through my life and doing meaningful activity.

I am asking you to explore what pain means to you and how you cope with it.  Have you been told not to do certain things? Have you decided that doing anything that causes discomfort is wrong? What things/movements might you be willing to explore, especially with the concept of dose?  And, ultimately to recognize that you are the driver of this mothership called a body, so you get to make the decisions.  I want you to trust in your capacity and make decisions that support you.

In exploration,
Laurie BB