Movement Recovery After Surgery (Part 3)

I’m six weeks post foot surgery and I’m feeling stronger and more stable every day. I’m well aware that the bunion I had removed didn’t develop overnight and neither did the subsequent movement imbalances and pain it contributed to. My return to strong, free, balanced movement is a process that is requiring me to be patient, persistent, and positive. I look forward to moving even better than I did before the surgery.

Let’s take a second to review:

When you suffer an injury or a surgery in one part of your body, the brain reflexively responds by tightening muscles in full body patterns: the front, back, or sides of the body contract. While the conscious, voluntary part of your brain makes sure you’re out of pain and nursing the injury (e.g. icing your foot, wearing your surgical shoe, using crutches) the unconscious, involuntary part of your brain takes care of keeping weight off that limb or area through muscular contraction. This compensatory cringing reflex is called the Trauma Reflex. You don’t have to tell your waist muscles to tighten to hitch your foot off the floor; it happens automatically.

Structure versus Function

Once your doctor has cleared you for movement, a daily practice of gentle somatic movements begins to reverse the tension your brain reflexively created in response to the pain and stress of surgery.

In my case, I had bunion surgery on my right foot. My brain responds involuntarily by tightening the muscles of the waist to keep weight off of my foot when I’m walking or, rather, limping around. The surgical boot creates a further imbalance as it is thicker than the shoe I wear on my other foot. If I don’t address this compensatory pattern, I may find my hip beginning to ache. This compensatory pattern of Sensory Motor Amnesia (SMA) exhibits itself as a Trauma Reflex. The following photos illustrate this pattern clearly.

Pictured: Front view of the Trauma Reflex caused by involuntary compensation in response to foot surgery. The surgical boot (left photo) further exaggerates my existing hip hike. After a short routine of Somatic Movement and wearing my normal shoe instead (right photo), my Trauma Reflex is already less severe.

Pictured: Front view of the Trauma Reflex caused by involuntary compensation in response to foot surgery. The surgical boot (left photo) further exaggerates my existing hip hike. After a short routine of Somatic Movement and wearing my normal shoe instead (right photo), my Trauma Reflex is already less severe.

Pictured: Back view of the Trauma Reflex caused by involuntary compensation in response to foot surgery. If not addressed, this Trauma Reflex can lead to myriad other aches and pains throughout the body.

Pictured: Back view of the Trauma Reflex caused by involuntary compensation in response to foot surgery. If not addressed, this Trauma Reflex can lead to myriad other aches and pains throughout the body.

For some of us there is a pre-existing a pattern of dysfunctional movement present even before we chose surgery. If you can nip this pattern in the bud, surgery may not be necessary. But if this pre-existing pattern of SMA is left alone, it can ultimately create structural issues that may only be solved through medical intervention. Your surgeon can “fix” the part of your that needs fixing, but your pattern of SMA will still exist — surgery does not “fix” your pattern of SMA. If you don’t address the compensatory pattern that developed over time (or in response to your surgery) you might find yourself having aches and pains in another part of your body. Only you can restore accurate balance and proprioception in your movement and release excess muscle tension.

In my last blogpost I discussed how my movement changed and the gradual improvement I’m making by applying somatic principles and movements to my rehab. It’s now time to address both the compensatory reflex at the center and the coordination of the periphery (in my case, the feet).

Try this:

Take a walk around your room. Notice your feet and legs. Notice the movement (of lack thereof) in the center of your body. Is there anywhere that you feel bracing or tension, right to left, front to back?

Watch this video and do the foot pandiculations I demonstrate. Do them on one foot first, then stand up, close your eyes, and sense the difference between that foot and the other one. Take a walk around the room. What’s changed? Repeat this with the other foot.

Now sit in a chair or lie down on the floor. For about a minute slowly move through Arch and Flatten, stopping at neutral after each repetition. Then do several Hip Hikers to get the pelvis swinging side to side as the waist muscles lengthen and shorten, always coming back to neutral. Finish up with a lazy, soft Washrag. Focus on releasing the center of the body yet connecting the tipping inward and outward of the feet to the movement you sense in the center. Bring the center and the periphery together. Stand up and take a walk around. Do you feel more balanced and connected now that you’ve addressed both the center and the periphery?

Your Somatic Movement practice is a daily opportunity to deepen your exploration of what an extraordinarily interconnected somatic organism you really are. Make use of the many support materials we have on the Essential Somatics store. Better yet, find an Essential Somatic Movement class in your area and start learning more. We are meant to move with intelligence, grace, and ease. Enjoy the journey!

Movement Recovery After Surgery (Part 2)

I am almost two weeks post-surgery and things are going really well. I’m feeling no pain when at rest and only slight discomfort if I push the limits of standing and walking. Thankfully I’m quite in tune with what my body feels and I listen very carefully to the messages it’s giving me.

I’m currently using a technique we employ in Clinical Somatics that is helping quite a bit; it’s called “means-whereby.” Means-whereby is the technique that FM Alexander used in his specific method of Somatic Education. It is an exploration of range of motion, done in a slow, exploratory way in order to notice and sense how you can and cannot move. There is never any forcing involved in means-whereby – only gentle movement, honoring your limits. This is beginning to bring back my ability to voluntarily move my toes; after almost two weeks of a sense of disconnection from my foot, this is a welcome improvement!

Restoring movement to the toes

Here’s what I’m doing: I’m passively flexing and extending my big toe several times, never going into a painful stretch. I’m testing my limits of comfort. Then I do the same thing with the other four toes. I follow with several repetitions of active flexion and extension of my toes and ankle, then move into inversion and eversion of my foot (which can be found on my Pain-Free Leg & Hip Joints or Pain-Free Athletes DVD). I can feel that jumpy, jerky, and shaky quality of movement so common in Sensory Motor Amnesia (SMA). This has developed due to having to keep my foot very still and then compensating when I walk —I’m currently putting more pressure on my heel so as not to place full weight on my front foot yet; I’m not ready for that. Because of this, the muscles of my lower leg are very tight.

How tension and compensation affect the body

This experience is a solid reminder of how heel pain can develop when you land predominantly on your heel and do not roll through to the front of your foot as you push off to take your next step. At the moment I cannot roll through my foot as I normally do, nor can I allow my hips to swing naturally. This has also created calf pain. This kind of unbalanced gait, while necessary for compensation until my foot is fully healed, could potentially lead to plantar fasciitis. I’m not concerned, however, since my daily Somatic Movement practice will restore balance in the center of my body and ultimately restore my gait to its normal, balanced state so that I can walk freely and easily.

One thing that is common after surgery that I’m now dealing with is fear: the fear of putting full weight on my foot and moving through the discomfort (not pain, just discomfort). I know my stitches are not going to burst and I know my bone is healing; my doctor assured me of this. Yet fear creates muscle tension and less than fluid coordination, which I can certainly feel. Our emotions create a muscular response in our bodies, and it can be hard to notice and correct those responses without a Somatic Movement practice.

So, what do you do? Graded exposure. Take things one step at a time (pun intended) and in small doses. Let your physical sensations and pain level be your guide, then add a little bit more each day until you’re beginning to feel comfortable and you trust your body. Know that you are merely going through a process in which patience is primary. Your body knows how to heal, so don’t rush it!

Additional foot explorations

For those of you looking to become more acquainted with your feet and relieve foot pain and tension, Laura Gates, CHSE has a wonderful 3-minute video to guide you through a few foot explorations. I look forward to doing these movements myself in the near future!

Movement Recovery After Surgery (Part 1)

I spent years as a professional dancer and model stuffing my feet into shoes that were often too small for my (very large) feet. I also danced in high heels and walked in fashionable, yet deeply uncomfortable shoes. Rarely did my feet feel comfortable and relaxed; this resulted in compensation for the discomfort in my feet and ultimately created structural problems in the form of hammertoes and bunions. I finally made the choice to have a large, painful bunion taken off my right foot and a hammertoe straightened and fixed. These structural issues were getting in the way of my favorite activity — hiking — and I’m too young to be hampered by them.

I’m very grateful for a skilled surgeon to fix what I cannot fix on my own, but now the task falls to me to use my Somatic Movement practice to re-educate my feet (once my foot is fully healed), legs, and center so that I can hike for as long as I live.

In the next several blog posts I will share my movement recovery with you so that anyone that is also undergoing or has undergone surgery will have the tools to recover their movement and prevent further musculoskeletal problems.

Pictured: Trauma Reflex while using crutches

Pictured: Trauma Reflex while using crutches

My first few days post-surgery have been spent resting and elevating my foot and carefully testing my movement limits.

I began using crutches when I arrived home and right away I began to feel the telltale contractions of the Trauma Reflex; my brain instantly hoisted my right hip up and my weight shifted to the left leg to take the weight off my foot. The voluntary part of my brain was focused on getting around without slipping or losing my balance. I will be using crutches for about a week and this pattern of shortening of one side of my torso to take the load off my healing foot will help me get around. It’s a very good thing — I just don’t want to get stuck it! For that reason the first movement I did as soon as I got settled in bed were Hip Hikers: slowly contracting one side of the waist as the other side released, then gradually lengthening it as the other side contracts. This gets the waist muscles back into smooth coordination with each other. It felt wonderful! I added my arms to this movement to create a gentle full body Human X. This movement released tension in my shoulder girdle and down into my back. I’ll be doing this movement quite a bit during my recovery.

Surgery isn’t just a “body” experience; it can have an emotional and psychological impact as well. It stops you in your tracks and demands rest and self-care and putting many things in your life on hold. I live an active lifestyle and being sedentary makes me anxious. Intellectually I know I need to rest, so my practice, even if for a few brief minutes, resets my brain to bring me fully into the present moment, with less fear, less tension, and more connection to my bodies.

Using crutches is a vigorous activity. If I get tired and slump down into the crutches it creates discomfort in my armpits and causes me to tighten and round forward in the center of my body. I’m using the crutches as a way to stand as tall as possible and use my arms to support me. This will help keep my front open and my breathing easy.

In just a few weeks from now I will be able to start putting full weight on my foot. I may have pain in my periphery (the foot), but it doesn’t mean my center (my waist, back, abdominals, and ribs) can’t move and relax. My practice will prepare me to walk with balance again. I’ll be doing seated Somatic Movements as well, and, when I can get up and down off the floor again I will return to the basic Somatic Movements we all need, beginning with arch and flatten and ending with the walking movements part 1 & 2. You can find this routine of basics on the Pain Relief Through Movement DVD.