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Even Alexander Teachers Can Have Arthritic Hips

Yes, Even Alexander Teachers Can Have Arthritic Hips

The Alexander Technique is sometimes thought of as a ‘cure-all’ but of course it isn’t. However, using the AT can help people manage and alleviate a wide range of conditions, which has been my experience with arthritic hip problems. Osteoarthritis is a degenerative disease of your joints, which  become painful and gradually stiffer. One of the main causes of osteoarthritis is overuse of the joints and another is genetic factors. Of course aging and general wear and tear also contribute. Several members of my family had arthritis and my brother has also had a hip replacement, so genetic factors probably contributed to my developing osteoarthritis.

Forcing a stretch can cause problems

My own story of hip problems started at the age of 5 when ballet lessons came into my life – I didn’t know it then, of course. I enjoyed dancing but always struggled to get a good ‘turnout‘, the outward rotation of my legs and hips, which is an essential part of classical ballet technique.  If I sat cross legged, my knees were always up in the air, and could not drop down. Not a big problem aged 5 but by the age of 8, ballet was getting to be a serious part of my life, so more effort was made to make me more supple and ‘stretchy’.

Aged 11, ballet became very serious, when I was accepted to train at the Royal Ballet School (White Lodge), where trying to increase my flexibility became a constant battle. Unfortunately, the term ‘battle’ is appropriate as I was always trying to force myself to stretch. I was an anxious and tense child, who found boarding school hard.  I wish I had been learning the Alexander Technique at that point and had learned to calm myself and also to yield to a stretch. Quite often my mother, or a teacher, would push down on my back or my legs to increase my range of movement there. No one mentioned that the shape and angle of the femoral neck as it links to the hip socket, would determine how far, or how little, I could achieve a good turnout. Trying to force my body to stretch probably contributed to my having back ache, a strained Sacroiliac joint and eventually, hip joint problems.

I became able to do the splits, as can be seen in the photo below and I could sit on the floor with straight legs and my head on my knees. I increased the amount I could bend backwards and raise my legs in the air. But my increased flexibility was hard won and my hips and turnout only yielded a little. I was used to my muscles aching but I wasn’t aware of what might happen to my bones. No-one mentioned the fact that some hip joints are shaped in such a way that they will never allow the legs to ease into a good turnout, or lotus position. But I kept trying…

Hilary King Doing the Splits in Welsh National Opera’s Bartered Bride, 1965

Penguin Walk

I developed a balletic gait, with my feet turned out as I walked – a ‘penguin walk’ as we called it. In walking like this, the outward rotation of the leg went right up into the hip joint as well. This habit stayed with me long after I stopped dancing in my late thirties but was greatly modified when I started having Alexander lessons. Thirty odd years of having been trained into an unhelpful habit, does make it far more of a challenge to change! I can still relapse into a modified version of this habit.  Dancing and moving in this unnatural way for so many years impacted on my body and probably contributed to arthritis developing in my hip joints. Arthritis is one of the conditions that many ballet dancers develop over the years. (Understanding hip pathology in ballet dancers: Yash Singh et al 2022)

I first noticed some hip joint pain when I was in my late thirties, doing a psychology degree as a mature and very stressed student. I had a 2CV car with a bucket seat which tipped backwards and the seat sloped back and down, so my knees pushed in towards my hip joints, which began to hurt. Fortunately I had been having some Alexander lessons by then, so I was able to help myself in several ways.

Letting go tension habits required practical and attitudinal changes

I realised I had a habit of tensing my legs and contracting them in towards my body when I felt stressed. This was more marked as I used the car pedals. To change the angle of my legs as I drove, I sat on a cushion. I also had another at my back, so I sat in a more upright and balanced position.  In my AT lessons, I learned how to drive the car more freely and to avoid contracting my legs tensely in the car.  I gradually developed an easier manner and was able to be less fraught and tense when sitting for hours writing essays and looking after two young children.

My walking gait changed, so I could walk in a more balanced way with more parallel feet.  My old sacroiliac problems eased and my hip pain went away for many years. Other huge bonuses were that my college work improved and I started getting higher marks – plus I could manage my stress better and I was calmer with my children, which they appreciated!

Osteoarthritis Diagnosis

It was another thirty odd years before I noticed my hips causing pain again, so I am grateful to have been able to use the Alexander Technique over the years, which helped me slow down the degenerative changes.  Eventually, however, my left hip felt as if it was getting rusted in!  It ached after walking any distance and during the night, so it constantly disturbed my sleep.  It was time to be referred to a consultant. The Xray revealed moderate to severe osteoarthritis and a date for a total hip replacement was put forward.

Once again, all the awareness and skills I have gained from using the Alexander Technique was invaluable to me during the period up to the operation and afterwards through my recovery. But more about that later….

A useful book for anyone wanting to help themselves with hip issues, has been published by an Alexander teacher in the US. Rodiger:  Mind and Mend your Hips. Better Hip Health  by Ann Rodiger

 

Hypermobility Syndromes

Joint Hypermobility Syndromes

The term Joint Hypermobility Syndromes, JHS, refers to the condition where a person’s joints are unstable because their ligaments are weak and loose (‘hyperlaxity’) and they may have poor muscle tone.  This means that joints tend to bend beyond the typical movement range. The Alexander Technique can help people with this and many of the other problems associated with joint hypermobility syndromes.

There are a number of diagnostic terms used to describe the various manifestations of the condition.  For these terms and further information on joint hypermobility syndromes visit the Hypermobility Syndromes Association, HMSA

Joint hypermobility can be a heritable disorder.  It can also develop through repetitive stretching as can be seen in dance, yoga and athletics training.

Asymptomatic Hypermobility

Roughly 1 in 10 people have some level of hypermobility but only some would call themselves  ‘double-jointed’.    Like many conditions, hypermobility syndromes come over a wide spectrum, from minimal to severe enough to be disabling.  However, most people experience very few problems and they have ‘asymptomatic hypermobility’.

This child’s arm shows classic signs of hypermobility in her elbow joint

Several members of her family are also hypermobile.

Symptomatic Hypermobility

A smaller number of people have ‘symptomatic hypermobility’.  Symptoms include:

  • Joint instability and hyper extension. This can lead to subluxations and even dislocations
  • Constant pain, with a tendency towards sprains and strains
  • Poor proprioception, balance and coordination. People often have flat feet and feel rather clumsy
  • Thin, stretchy skin that bruises easily and takes a while to heal
  • Bowel and bladder problems
  • Autonomic disfunction with dizziness and fainting, particularly when standing up quickly. (PoTS) . they may also have poor temperature regulation
  • Chronic fatigue

Some Signs of Joint Hypermobility

This photo shows some mild joint hypermobility in the shoulders, elbows and thumbs

Hypermobility Syndromes and the Alexander Technique

Alexander lessons can help many people with hypermobility issues, particularly those to do with proprioception.  Gaining more sense of where our body is in space can help improve our coordination, balance and confidence. Learning how to reduce tension can also reduce our pain and help improve energy levels.

I personally have taught many pupils with general hypermobility syndrome. One pupil could stand with his body facing me but have his toes pointing behind him! An interesting example of unstable joints and hyperlaxity.  I have also taught clients with Ehlers Danlers Syndrome, EDS, and Marfan Syndrome, MFS, which are two of the more severe forms of JHS conditions.

The NHS Consultant Rheumatologist Dr Philip Bull FRCP, who is on the HMSA Medical Advisory Board, is a great advocate of using Alexander Technique lessons for hypermobility patients, often alongside Physiotherapy.  He has seen how hypermobility syndrome patients are helped by learning the Alexander Technique and has written articles on the topic. Dr Bull states that ‘patients with hypermobility found it particularly helpful; some even life changing’ .

You may read and download Dr Bull’s article about Hypermobility Syndromes and the Alexander Technique  here.

 

 

Crepitus

Crepitus comes from the Latin for ‘a crackling or rattling sound‘ and it is a medical term that refers to all those little clicks, cracks, pops and grating crunchy noises that can be experienced when we move around.

Crepitus can occur when bones in our joints rub together as a result of damage to the cartilage, to the bone itself as in osteoarthritis, or sometimes when there is damage to an intervertebral disc which could result in the vertebrae rubbing against each other. It is possible to hear these noises, the grating can very often be felt internally and may or may not be associated with pain. An audible sound of crepitus can be one of the symptoms of bone fracture.

It is also possible to have little popping noises occurring in our lungs or soft tissues when there is an abnormal area of air or gas under the skin. This type of crepitus does not concern us here as it tends to occur in various severe conditions that require medical intervention, which is not the remit of the Alexander Technique.

However, the crunches that are experienced in our joints are relevant to Alexander lessons. If we contract our muscles and increase the tension around our joints with our habits of compressing down into ourselves with misuse, then crepitus is more likely to occur. When we hear those crunching sounds, they can be a useful reminder and warning that we need to allow our muscles to unwind and free up. If crepitus is persistent or severe, it may be wise to seek a medical diagnosis as to the cause.

When we can learn how to allow our musculature to be more elastic and freely lengthening, it is possible to reduce the pressure around our joints and allows them to move more freely, which often reduces the crepitus.

Orthostatic or Postural Hypotension

Orthostatic Hypotension or Postural Hypotension

Orthostatic Hypotension is the somewhat uncomfortable dizziness or ‘head rush’ sensations some people experience upon standing up.

When we move into an upright position too quickly, our blood can remain pooled in the lower part of the body, so there is not enough blood being pumped up to the brain, making us experience dizziness and other symptoms, usually on a temporary basis. 

Mild symptoms of Postural Hypotension often happen when people stand up abruptly and this is caused by a temporary drop in their blood pressure. It is more common in the elderly, in someone with low blood pressure, or possibly as a side effect of drugs but it can also be present in certain illnesses and physiological conditions that may need treatment.

If you experience symptoms of Postural Hypotension on a regular basis, this indicates that you need to visit a doctor in order to have your blood pressure checked and to see if there is an underlying condition which may be contributing to the problem. 

Postural Hypotension Symptoms are variable : 

Dizziness; Faintness; Nausia; Visual disturbances.

Shock

Similar symptoms may be experienced with shock, so it may be necessary to diagnose the cause of the symptoms if they are experienced strongly or frequently. Physiological shock can be life threatening and needs immediate treatment.  Profound psychological shock can leave us with symptoms that are experienced for some years, for instance in Post Traumatic Stress Disorder (PTSD). 

Light-headedness

Less worrying and more common is the light-headedness and occasional other temporary symptoms, that can sometimes happen if people get up too quickly, for instance after practising the AT lying down procedure – so it is important to remember not to end gain and rush into getting up but to bring yourself back up to standing in a measured and thoughtful manner. If you are concerned about frequent dizziness or other symptoms, do visit your doctor.

Text Neck

Text Neck 

Text Neck is a buzz word used to define the syndrome that causes pain in the head, neck and shoulders, which is brought on because of the over-use and mis-use of smart phones, tablets, laptops and suchlike.

People often use this type of equipment on their laps, so they habitually pull right down towards the screen in order to use them. This means the heavy weight of the head is dragging down and over-stretching the muscles in the neck and shoulders, often for long periods of time. This strains the muscles and interferes with the finely-tuned balance of the head and the neck, which results in pain.

Unfortunately many young children have already been diagnosed with having painful Text Neck and this could continue to cause problems later in life if not addressed. However, if these unhelpful habits are recognised, altered and people can learn how to let go of them, then they can begin to reduce and even stop the pain.

Torticollis or Wryneck

Torticollis – Wryneck is a form of Cervical Dystonia

Torticollis is a condition where a person’s head and neck are constantly twisted by spasms in their neck muscles. These contract down towards one side all the time, often with abnormal rigidity. This old Private Eye cartoon says it all! Torticollis may develop gradually or suddenly and babies may be born with Congenital Muscular Torticollis.

Acute Torticollis or Wryneck

This is the term given when the condition arrives suddenly. For instance a person may wake up to find they slept in a distorted position and have such a stiff neck that they cannot move their head from side to side. This problem often resolves itself fairly quickly.  But a wise person would ask themselves what they might have been doing to bring it on and then find a way of avoiding it happening again.

Diagnosis

When severe, torticollis may be associated with damage to the cervical vertebrae and discs. Diagnosis is essential when there are symptoms such as chronic neck pain with numbness in the hands and arms. This numbness not only poses a threat to many careers but indicates an underlying problem where the nerves are being irritated.  The cause needs to be known, to check for a prolapsed disc and to rule out illnesses such as meningitis, particularly if the person has a fever.

Causes and Development of Neck Pain

Torticollis can be caused by accidents, injuries, tissue scarring and shrinkage.  It can also be brought about by mental states such as anxiety and habitual patterns of poor body use, as in the image above.

Poor posture and long-term mis-use of the body, that disturbs the natural muscle balance in the neck, can lead to the gradual development of torticollis. Unfortunately, many children hunch over school books, holding the pen in a contracted, twisted manner whilst writing. This is a habit they often take into adulthood and then gradually develop neck pain – unless they learn to let go of the habit. Also babies whose heads are left lolling down to one side as they sleep in pushchairs, must be vulnerable to wryneck developing. Over time the neck muscles can get used to being contracted in this way and they become fixed so that torticollis can develop.

There are also work situations which require a person to incline their head and body in one direction constantly. Radiologists for instance, or violinists, often resort to pulling their heads down to one side quite tensely in order to work or hold the violin in place. Dentists often lean down over patients at an angle and a twist – for hours on end all their working lives! If such activities are performed without looking after the head-neck-back relationship and general body use, then problems such as torticollis and neck pain are likely to develop.

Treatment 

In extreme cases, botulism can be injected into the muscle to stop the spasm for a few months. Surgery to partially cut and release the contracted muscle is sometimes used as a last resort.  Physiotherapy to help stretch out the muscles can be helpful.

Can the Alexander Technique help Torticollis?

Fortunately, it is possible to improve one’s body use by learning the Alexander Technique so we can avoid the habits of twisting and contracting that contribute to torticollis. Through the gentle guidance of the Alexander Teacher, it is possible to re-educate muscles so that they can relax and ease out of the neck spasm.  This puts less pressure onto vulnerable discs and nerves and begins to re-establish the natural head neck back relationship.

Many violinists for instance, have been saved from constant pain which could threaten their careers, by applying the Alexander Technique to playing.  They can learn to hold and play their instrument in a manner which does not cause them harm. When they learn how to maintain a freedom and resilient lengthening of their muscles, they can avoid going into spasm whilst playing.

Research into the Alexander Technique and Neck Pain

More generally, a major research study, the ATLAS Research Trial (2015) has shown that the Alexander Technique produced “clinically relevant reductions in neck pain and associated disability” for people with chronic non-specific neck pain.

http://annals.org/article.aspx?articleid=2467961 

If you would like to discover how the Alexander Technique can help you with neck pain and other conditions, you can contact me to arrange an Introductory Alexander Lesson:

Contact Hilary King

Tinnitus

Tinnitus is a condition in which a person hears various noises in the ears. These sounds come from an internal source in the body, rather than from sounds in the outside world and include ringing, hissing, whistling, clicking and buzzing noises. 

Tinnitus may be occasional or continuous, temporary or permanent, in which case it can impair a person’s hearing and quality of life.

Causes of Tinnitus

There are many different causes of tinnitus, some of which are medical conditions that might require a Doctor’s diagnosis and treatment, so it is wise to get checked out by your Dr.

Continuous exposure to loud noises can contribute to tinnitus, so musicians and people who constantly hear music and other loud sounds can become affected. Other causes of tinnitus are damage to the ear or ear infections, head and ear injuries, the onset of hearing loss, plus high stress and anxiety levels. Many people with tinnitus find the condition distressing and become even more tense and upset because of the continual noises interfering with their hearing. This is likely to make the condition worse.

Treatments for Tinnitus

There is no medical treatment available for tinnitus, although people can be referred to Tinnitus Clinics where Cognitive Behavioural Therapy (CBT) and other techniques are used to help people relax and reduce the emotional distress they experience, which helps them reduce and cope with the tinnitus.

Alexander Technique and Tinnitus

The Alexander Technique can be of great help to tinnitus sufferers. The main learning in the Alexander Technique is to allow the muscles around the head, neck and back to work in a coordinated and free manner, so that habitual patterns of tension and mis-use are reduced or eliminated. This freeing-up of the head and neck muscles has an impact on the levels of tension around the ears and often reduces or even stops the irritating sounds that people experience. 

The Alexander Technique also uses the ‘Whispered Ah’ procedure, which specifically works with freeing up the muscles around the head and neck, plus the throat and jaw, which hinges just next to the ears, so tensions here can impact on the function of the ears. The whispered ah procedure can be very helpful for tinnitus sufferers to learn and use, as it often produces an immediate lessening or cessation of the tinnitus.

Importantly, Alexander Technique pupils also learn to stop getting back into the habits of tightening up around the head, jaw and neck, so that they gain a tool with which to avoid the tensions which can contribute to the creation of tinnitus.  Various pupils that I have worked with who have had tinnitus, have found that their Alexander Technique lessons have helped them to reduce and have some control over the problems associated with this condition, in a way that they have not been able to do so before.

Spondylosis

Spondylosis, or Spinal Osteoarthritis, is a degenerative disorder of the spine that affects the intervertebral discs, sometimes resulting in pain, loss of function and structural distortions.

Spondylosis is an age related disorder and is often referred to as ‘wear and tear’. As we age, the cartilage which forms the discs becomes more brittle, dehydrated and narrow, which can make the spine less stable, particularly if we do not pay attention to the way in which we use our bodies.  This instability can sometimes lead to the vertebrae developing bony spurs called osteophytes in an attempt to stabilise the spine, but these extra bits of bone can themselves create pain and other problems, by pressing on nerves and blood vessels. The spine can also become more stiff and rigid, particularly if we tend to hold ourselves tensely and are fixed into habit patterns that contract us, rather than lengthen the body and musculature, so our movements become less free. 

The degenerative changes brought about by spondylosis may be found throughout the spine, i.e. in the cervical (neck) area of the spine, the thoracic area (the mid-back) and in the lumbar area (the lower back). The patterns of degeneration will vary from person to person and will reflect the way each person uses and mis-uses their body. The more we interfere with the way the body is designed to work, the more we lose our natural poise and this can create distortions in our structure, which will get exacerbated by the spondylosis.

The more downward compression we put onto our discs, through continually sitting in a slumped position or over-arching the back for instance, the more the discs will lose their ability to retain their fluid content, so they will not be able to fulfill their functions as shock absorbers and stabilisers between the vertebrae.

Fortunately, in Alexander Technique classes, we can learn to reduce this downward compression onto our discs and to regain the natural balance, co-ordination and alignment of the body, thereby helping to slow down the rate of degeneration and the discomfort that spondylosis can cause.

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