“How has it been since last time?” I asked Mia, a woman in her late fifties, when she arrived for her fourth lesson. She came for lessons because of severe knee problems especially in her right one, where the cartilage was in bad shape.
“Much better, I have reduced the number of painkillers and it is easier to bend my knees. My homework went great.” (I had given her a tape with a “frog leg” ATM)
“That’s great, what are your wishes for today?”
“Well I still have difficulties putting weight on my right big toe, both in standing and in
walking. As soon as I don’t concentrate, I find myself back in my old pattern,” she replied.
“What do you do then?” I asked.
“Well I try to think about what we did last time when you helped me to keep my length on the right side when I stepped on that foot and it gets a little easier.”
How could I help her maintain this organization without having to stay overly conscious about it? Last time I gave her a lesson she was lying on her left side and I followed her pattern and helped her shorten her right side and in the end she was able to lengthen this side more easily. I had also done some work with her feet on a small roller and this helped her to be more aware of how she used them and it also made it possible for her to use the inside of her feet differently.
A process I have seen both Gaby Yaron and Larry Goldfarb do came into my mind, using a big roller both in sitting and lying with the back of the pelvis on it. I thought that it might be easier for her to leave her old patterns if she was sitting and lying on a roller. And maybe if I give her the same message as in the last lesson (being long when stepping onto the right foot) but in another position, it would be possible for her to make it a part of her movement vocabulary. Also when lying on the roller, it would probably be easier for her feet to stand more under her knees and have the pressure more between the first and second toes and more towards the first metatarsal. In earlier lessons we had found that, when she put the pressure through this part of her foot in walking, her knees felt better. I also thought this position would give me greater access to her lower back and her ribcage and it would be easier to help her lengthen and shorten both sides.
I had her sit and asked her to notice how the pressure was distributed on her buttocks. At first she felt no differences. I wondered how I might help her note differences more clearly. I asked her to round and extend her back while noticing the pressure on her buttocks. She could then feel that when rounding she came more over on the right side. Then I asked her what happened with her knees when she did that, and it was obvious for both of us that her right knee moved more to the outside. Then I asked her to pay attention to where in her back she moved and worked the most. This was something we had done in the last lesson, in side–lying, and we found that it was the same as last time, that she had difficulties moving in her lower back and letting go of her stomach.
Although this had shown up in the last lesson, I hadn’t been aware that the pattern of holding in her stomach was so strong in her, but I hoped that it would be possible to address both this pattern and her pattern of shortening her right side. And to do it in a position she wasn’t used to would hopefully be effective. I decided to go on with the lesson.
I had her sit on a big roller and roll it forward and back. I wanted to see if this changed the way she used herself. I hoped that the roller would help her use her lower back more. Spontaneously she rounded her back when she rolled the roller back and extended it when she rolled it forward. Without the roller, there hadn’t been much movement in the lower part of her back. I then asked her to do it the other way around (move the roller back when extending and move the roller forward while flexing). I thought that this would further inform the way she used her lower back. This was quite difficult for her but after doing it a few times it started to get a little easier. Then she noticed that it was even easier when she used her legs more. I hadn’t been thinking about the use of her legs, so when she said it to me I had her (and me) focus even more on her knees and feet. We then played a little with putting weight on different parts of her feet while rolling the roller back and forth. During this experiment, she kept on extending her back when the roller moved back and rounded it when the roller moved forward. I then asked her to notice how her back was moving and it was clear to her that there was now more movement in the lower part of her back.
Thanks to her awareness and quick response, sitting on the roller seemed to help with how she used her lower back. It also gave her more awareness of how her legs could be part of this action and reminded me how they were involved as well.
After this, I had her lie on her back on the table and placed the roller under her pelvis. I began palpating the muscles in her back and, as I had found earlier, there was a higher tonus on the right side than on the left. This time it was obvious for her too which made me glad because this was the first time she noticed the difference in the muscle tonus between the two sides. I lightly pulled through her legs (feet standing while holding on the femoral condoyle). I could feel that the pulling went through much easier on her left side, where movement reached her head. On her right side it stopped somewhere in her waist. When I asked what she noticed, to my surprise, it was quite different than what I was paying attention to. She felt that her right hip was looser than her left. She wasn’t at all aware of what was going on in her trunk.
I then pushed from her knees up through her head and when doing this, I could also feel that the movement went through more easily on her left side. Here too there was a difference between what she and I were feeling and noticing. I was a little bit puzzled with this but realized that if we weren’t able to observe the same phenomena it would be difficult to continue along this track. So I did the pulling and pushing in different directions while directing her attention to different parts of her body. During this process her awareness of what was going on increased and after a while we could both agree with what was happening. She realized that the reason that she felt her right hip to be looser had to do with the fact that there was less movement in the right side of her trunk so her hip joint stood out more. After doing this for a while she could notice that the movement went through more easily on her left.
I returned to palpating the muscles in her lower back and asked her what she felt. She answered that the muscles felt softer than in the beginning, especially on the left side. That was similar to what I felt and I was relieved that we now were noticing the same things. I then supported the right side of her lower back, lifting it up a little while at the same time moving the right side of her pelvis and her right shoulder slightly towards each other. “That feels good,” she said, and after I stopped the movement we could again both feel that the muscles on her right side where a little bit softer. Then I came back to pulling and pushing through her legs and I was pleased to find that she was more aware of what was going on. The differences between the two sides were much smaller than before but still there where a difference between her two sides that I felt needed to be addressed. It was as if something was holding in the region of her right hip and then I remembered that she had mentioned something about being sore in her right groin. So I thought that iliopsoas could have something to do with it.
In this part of the lesson, I was a little bit unsure if it was appropriate or not to make more
differentiation. I think I could have left the next step out, thinking that maybe her nervous system would take care of it by itself, but after having her rest for a short while off the roller, I put her back on the roller and continued on.
I lifted her right leg and palpated her in her groin and found she was sore here and it was difficult for me to reach into her hip joint. On her left side she felt no soreness and my fingers could sink deeper in without any resistance. She also said to me that her right leg felt heavy. I went on doing the following with the hope that it would help clarify her hip joints and allow her iliopsoas to let go. I held one leg and had the other one standing (still with her pelvis on the roller). Then I moved her pelvis (producing extension and flexion in her lower back). This was done with her leg and pelvis held together, with her pelvis fixed and moving her leg, with her leg fixed moving her pelvis and moving both her pelvis and leg in different directions. I started on her left side where she had no problem of letting go. When I came over to the right, it was more resistant and it was very difficult for her to let go of the leg. I then went back to her left side and asked her to produce the same resistance on this side that she felt on the right. After changing sides a couple of times, it became clear for her that the work she was doing in her right hip wasn’t necessary. In the end, I held her leg and had her move her pelvis, extending and flexing in her lower back. It was now easier for her to let go of her right side and she now noticed that her feet were also standing much more stable.
I ended up what we were doing on the roller by taking her into flexion, lifting up her knees having her lower legs hanging. She immediately noticed that her knees bent more than usual. And when the roller was taken away and she put her legs standing, she spontaneously said that her legs felt more stable.
“How come?” I said. –“What is the difference?”
“I think my feet are standing closer together and closer to my buttocks”, she answered.
“Can you lift your pelvis now”, I said.
She did and it felt much easier than it used to. I then had her lift her pelvis with her feet
placed in different positions to help make her aware of the choices now available to her.
After this, we came back to her sitting on the roller and I asked her again to roll it back and forward. To her own surprise, she started to roll the roller back and at the same time extend her back. I myself was also a little surprised (even a little relieved) that she found it so quickly. Then I asked her, “What about your legs?”
“I use them much more and it is easier than in the beginning”, she replied.
Then I asked her to roll it the other way around (rounding the back when rolling the roller
back). She now found this more difficult and also noticed that it was more difficult to move in her lower back and use her legs. Away with the roller and back to sitting on the table, she felt that she sat more balanced and more in the middle.
At the end of the lesson, when she came up to walk, she spontaneously said that it was easier to have the pressure on the big toes of both feet (this was actually more between the first and second toes, towards the first metatarsal, but I wanted to use her language here). I think that this happened because of the changes that resulted from when she was lying with her pelvis on the roller with knees bent. In this position, her feet could come more under her knees, making it much easier to feel the pressure through the front of her feet. Working with her in this “environment” allowed her to more clearly learn and sense how to do this. I was very pleased with how the lesson had evolved even though in some part of the lesson I wasn’t sure if I had done too much. I could see that her walking had improved a lot and I think that her awareness of what is going on, how her knee problems are connected to how she uses the rest of herself, has increased,
What would be the next step? I am not sure, but this lesson on the roller was one step towards having her heels more under her pelvis and on the way to this it will give a lot of opportunities to work with the movements in her lower limbs and in the knees. It will also provide an opportunity to work more with finding the best place to put pressure through her feet. There is a wonderful series of ATM´s starting in AY#190 and I think working with her around them will provide plenty of material for many FI´s. in these lessons Moshe emphasizes, again and again, to have the pressure on the feet, somewhere between the first and the second toes.
Probably I will also do some work with her kneeling at the table to help further clarify her hip joints and how she brings her weight over her legs. Maybe it could be a way for her to be able to sit more on her heels as well. If this doesn’t work out, I might have her lying on her stomach and from there work with having her push with her big toe, and maybe also do something that could support more flexion in her knees.
But I have to wait and see how she digests what happened during this lesson. Maybe I will need to go back to do some more work differentiating her feet (which I did in the second lesson with her) but I will have to follow her cue when she returns.
Anyhow, I am looking forward to the next lesson.
Nygatan 88, S-231 45 Trelleborg
feldengood [at] telia [dot] com