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Stenosis

Stenosis is a term that comes from the Greek word that means ‘narrowing’

Stenosis is the abnormal narrowing of a tubular structure within the body, such as a duct or blood vessel. This narrowing to an internal passageway, usually creates some sort of blockage or pressure which causes problems and pain.

The condition that is frequently seen by Alexander Technique teachers and is therefore of more relevance to their work with their pupils, is spinal stenosis.

 

 

 

Spinal Stenosis

Spinal Stenosis is the narrowing of the spinal canal and can occur in the cervical, thoracic or lumbar areas of the spine – or sometimes in more than one area at the same time. This narrowing can be brought about by the degeneration of the vertebrae through conditions such as wear and tear from ageing or from general mis-use of the body which creates a continual downward compression through the spine. Other causes are tumours, osteoporosis and a number of pathological conditions. 

Spinal stenosis can also be created by a prolapsed or herniated spinal disc, which can bulge and get pushed out of place, narrowing the spinal canal,  thereby compressing and damaging the spinal cord and nerves. This can cause acute and sometimes chronic back pain. Gradually, if the problem is not addressed, the condition can also lead to numbness, weakness and sometimes a reduced ability to control limb movements, bowels or bladder.

As a final resort, decompressive surgery may be used to relieve the condition.

However, many people would prefer to avoid surgery if possible and it is at this point that they may start Alexander Technique lessons. Over the years, many pupils have indeed avoided having spinal surgery in this way.  

Someone learning the Technique can begin to use their bodies more freely and in a more aligned manner, so that their musculature can relax and begin to lengthen out again – rather than being tightly contracted and creating the downward pressure through their bodies that causes restriction and damages the spine and other parts of themselves as they move around.

Instead of this unhelpful way of using their bodies, pupils will learn to bring about a more buoyant and expansive way of moving around, so that they relieve the pressure on their discs and vertebrae. In this way their discs are often able to regenerate, at least to a degree, which allows the vertebrae to re-align enough to reduce the pressure on the spinal cord and spinal nerves.

Our spine is a little bit like a drinking straw in that if you push down onto a straw, it will buckle and in doing so will stop any fluid going through. If you lengthen the straw out again, fluid will once again be able to go through the gap in the middle.

If the spinal stenosis has been caused by something like a tumour, then it may be possible to use the Alexander Technique in the way outlined above, in order to minimise the discomfort and to stop any avoidable pain.  However, if the stenosis has mainly been brought about through the way that a person has been using their body as they sit, stand and move around, they can often reduce the pain almost entirely through using the Technique.

The fact that learning the Alexander Technique can help someone to reduce chronic back pain, which may have been brought about for a variety of reasons, has been supported by the ATEAM Research Trial, which was published by the BMJ in 2008.

Disc Prolapse (Slipped Disc)

A Prolapsed or Herniated Disc comes about when extra pressure is put on the intervertebral discs so they become compressed and damaged, forcing the internal pulp of the disc away from the centre, to bulge out through the fibrous exterior. This is particularly true if the pressure put onto the discs is uneven. In severe cases, the disc’s fibrous wall breaks, so that the pulp is squeezed through it to press on nerves leaving the spinal cord. Predominantly, this happens to the two discs just above the sacrum, leading to the sometimes agonising pain of sciatica.

Most people have slipped discs in the lumbar region of the spine, so they experience lumbago and lower back pain which is sometimes severe and disabling. Roughly 95 percent of cases of disc prolapse are in the lower back, with about 5 percent of injuries occurring elsewhere in the spine, mainly the neck, or cervical region

Symptoms

The symptoms of disc prolapse are lower back pain and, in the case of sciatica, pain that runs down the back of the legs. There may also be tingling, numbness and weakness, indicating some damage to the nerves, which needs to be addressed as soon as possible.

Causes

Disc prolapse can be caused by accidents and lifting heavy objects, or from over-exertion and habitual mis-use such as bending down in ways that compress and mis-align the spine. A typical habit that causes problems, is to curl down and contract the spine whilst bending over and/or lifting. This makes the muscles work unevenly and compresses the intervertebral discs, often at an odd angle. However, it is possible to inhibit such habits of mis-use and to learn an improved manner of use which protects the spine and puts less pressure on the discs. In this way you learn to bend the knees and fold at the hip joints whilst bending forwards or squatting, all the time giving yourself directions to freely expend into the movement. This allows the spinal column to remain lengthened and resilient and your body can function in the way it is designed to.

Sudden movements or the spasms created by coughing and sneezing, for instance, can also irritate the nerves and cause pain. If you have this problem then bending your knees when you cough can protect your back but it is only part of the answer.

Treatment

Whilst rest, surgery and treatment such as physiotherapy and gentle exercise may help the condition, there will be no long term improvement for most people, unless they change the way they use their bodies. Dr Wilfred Barlow states: ‘My own experience, quite categorically, is that most forms of back pain, even after there has been successful surgery, are best treated by making USE re-education a prime necessity.’ Wilfred Barlow MD ~ p105 ~The Alexander Principle

Many people have found that by learning the Alexander Technique, they can begin to use their bodies in a more aligned and aware manner and gain a tool that helps them not only heal their back pain but stops them falling back into the old habits that contributed to the disc damage in the first place. Also, the use of the lying down procedure is a more powerful tool that helps heal the back, than merely lying down and resting. I have known Alexander Technique pupils, that had been hospitalised, come off all pain killers after having just a few Alexander lessons. Over time they have learnt to avoid moving in ways that cause problems, freeing themselves from pain and managing to go back to work or have another baby when, before having lessons, they thought it was not possible to do so.

Tendinitis

Tendinitis is defined as the inflammation of a tendon. There may be tenderness or pain, plus swelling which can restrict the movements available to the muscle that is attached to the tendon. Sometimes the skin around the tendon becomes red and feels hot to the touch.

Causes

Tendinitis can come about as the result of infection, irritation or an injury to the tendon. Frequently, tendinitis is the result of continual overuse and misuse of the tendon, which will be linked to general misuse of the body and the whole self. For this reason, tendinitis is often included under the umbrella term of Repetitive Strain Injury.

For instance, the Achilles tendon in the back of the heel is not very elastic and can be strained by wearing unsuitable shoes. Also, many people have an end gaining attitude towards exercise and keep pushing themselves so that they overuse or over-stretch the tendon, which results in it becoming inflamed – or even torn and ruptured.

Treatment

The medical treatment for most types of tendinitis usually focuses on reducing the symptoms and includes anti-inflammatory drugs or corticosteroid injections to the area around the tendon. A physiotherapist may suggest some exercises and use ultrasound for the condition.

Whilst such treatments may bring about temporary relief, if the underlying habits of misuse that are the predominant cause of tendinitis are not addressed, then the condition may well return. However, by learning and applying the Alexander Technique to everyday movements, one can maximize the possibility of avoiding a re occurrence.

Tendinitis in the Achilles may require a plaster cast to restrict movement in the ankle, whilst the tendon has a chance to heal. In extreme cases, where the tendon has ruptured, surgery may be required. After such severe problems, learning and using the Alexander Technique in order to walk around in a way that lets go of any limp and avoids re-straining the Achilles, would be a wise move.

For more information, you may read my article on Repetitive Strain Injury

Repetitive Strain Injury (RSI)

Repetitive Strain Injury, or Occupational Overuse Syndrome, is a general term that covers a variety of overuse injuries to muscles, tendons and nerves, predominantly of the forearm, wrists and fingers. RSI is an increasingly common condition that affects many people who, for instance, use machines that vibrate constantly, play a racket sport, use a keyboard or play a musical instrument. Such activities require repetitive movements of the fingers and wrists, often at speed, for hours on end.

Medical treatment for Repetitive Strain Injury includes rest, anti-inflammatory medication, pain killers, steroid injections and physiotherapy. The NHS Direct Website also states that learning the ‘Alexander Technique… may help’

Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS) refers to the pain, numbness and tingling in the thumb and three fingers, that comes about when the median nerve in the wrist is compressed. The pain can radiate up the forearm and is often worse at night.

Carpal tunnel syndrome is a progressive condition, so it is important to recognize the early symptoms and take action. Left untreated, there can be a gradual loss of sensation in the hands which become weak. This can lead to a loss of grip so that items are dropped from the hands, plus a tendency towards clumsiness that can make it hard to do activities that require fine and precise movements.

CTS is often included under the umbrella term of Repetitive Strain Injury, or Overuse Syndrome.

For more information, you may read my article on Carpal Tunnel Syndrome.

Lordosis

Lordosis

Lordosis is the term given when there is an exaggeration of the natural curve in the lumbar region of the spine, which creates an over-arched lower back.  Some people are born with this condition but many  people develop it over time. Factors such as poor use and posture, and the wearing of high heels can contribute to this condition. For instance, many pregnant women carry their ‘bump’ – their babies – with a very pronounced curve in their lower backs, which could often be reduced if they used their bodies differently. They may then go on to carry the baby in their arms in such a way that they continue to increase the lumbar curve and then they experience lower back pain.

Lordosis can often result in the compression of the intervertebral discs between the lumbar vertebrae, causing  lumbago and even the severe pain of a prolapsed disc (slipped disc).

This sculpture at Kew Gardens shows a somewhat exaggerated lordosis in this young woman. In a real person, this pronounced arch may reduce when she stood upright or sat down, so the curve may lessen but frequently, if this is a way of habitually using the body, it tends to get fixed so lordosis develops into a condition, not just an arching movement.

Sculpture illustrating lordosis

Kyphosis

Kyphosis

Kyphosis is the term given to an exaggerated dorsal curve of the thoracic region of the spine. This can come about, for instance, through sitting curled over a desk for long periods of time, or by constantly bending down towards small children or work surfaces.  Kyphosis not only causes discomfort in the neck and upper back but can restrict the functioning of the lungs and other internal organs. The curvature of the upper back and chest can also put pressure on the nerves of the upper arms and contribute to problems such as RSI.

The imbalance created by this curvature in the upper body, is often compensated for by the spine which also develops lordosis, an exaggeration of the lumbar curve in the lower back.

If the Alexander Technique is used early enough, it is often possible to prevent kyphosis from developing and if learned later on in the condition’s development, it can help reduce further degeneration.

This great sculpture called ‘The Scholar’ by Tapfuma Gusta, which I photographed in South Africa, clearly shows the upper spine and body curving forwards and down – presumably towards his desk after years of writing and reading many many books.

Lumbago or Low Back Pain

Lumbago or Low Back Pain

Lumbago refers to both mild and severe low back pain which causes discomfort in the area of the torso between the top of the legs and the base of the ribs. This is often associated with an over-arched lower back, Lordosis.

Sometimes lumbago is related to a specific condition such as an intervertebral disc prolapse, scoliosis or strained ligaments, but in most cases there is no obvious medical cause to be found. People can experience acute back pain which arrives suddenly, as the result of an accident or, for instance, from making a movement such as lifting twisting or bending in a way that compresses and sometimes mis-aligns the spine and leads to a slipped disc. If there is also numbness, weakness and tingling in the legs or lower back, it is essential that a doctor is consulted to diagnose the condition, as there may be some nerve damage that needs attending to.

Lumbago can also develop slowly as a result of habitual mis-use and can, without changes being made to the way the person uses their back, develop into chronic back pain. An Alexander Teacher can help someone with lumbago to recognise and understand their habits of mis-use which have contributed to, or created, the conditions for back pain and stiffness to develop. Mis-use comes in many forms and often the muscles and ligaments in the lower back become permanently contracted and painful – some people have poor posture and muscle tone, others may react to stress by continually tensing their back muscles and many people strain their backs by lifting heavy objects without due care and attention.

It is possible, through Alexander Lessons, for people to be taught how to inhibit and let go of habits that cause problems, then they can learn to improve the way they use their bodies and direct their activities. This can help people free their muscles from chronic tension, so they are often able to reduce or eliminate back pain entirely. Lessons can also help those who are recovering from an acute condition and give people a technique they can use to help prevent a recurrence of the lumbago.

The lying down procedure, as taught in the Alexander Technique, is a particularly useful tool to use in order to help the lumbar region to free up, so that contracted muscles can release painful tension and gradually lengthen out again.

The results of the ATEAM Research Study published in BMJ Online,19 August 2008, show that learning and applying the Alexander Technique significantly reduces low back pain and improves the quality of life, with the effects still evident a year later. The Conclusions were that One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons’.

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain BMJ 2008;337:a884