Sunday, August 17, 2014

Trainers, Be Trained (or, I Might Do A Cartwheel Some Day)

"I don't know if I'm up for this, Bobby. My triceps are fried."
"Good thing we're not using our arms, then, Amy: it's deadlift day."

Flip the speakers, and the exchange could have taken place between me and one of my personal training clients. With them, I'm kind but firm, finding their limits and pushing, pressing or pulling our way past them. Instead, Bobby was pushing mine, zeroing in with his trainer's eye on the gap between my work capacity and insecurities. It would go like this: he'd ask me to do something; I'd say no; he'd say yes you will too; I'd point to an old injury; he'd get in spotting position; I'd make a face; he'd say go; I'd do it. Seven sessions together, and this scenario played out each and every time.

A nice, inspiring end to this story would include success in these moves, but I'm here to say that some of my initial attempts--cartwheels, somersaults--were kind of ugly. And that's the point: I paid someone to help me find my limitations. I know my strengths, which just that: strength. I can pick up something really heavy one time and put it down. Bobby wants to make sure I can do some other stuff--eventually--and do it well.

I came into this profession in my late thirties a brand-new convert, with as much or more enthusiasm than the kids waving their exercise science degrees. Enthusiasm can go a long way, as can all the self-study and work experience I undertook, but it can't cover a missing history of participation in sports and the chance to observe a range of coaches. I'm proud of every hour of personal training I've led, but the more I know, the more I find I don't know.

Enter Bobby. I've been eating humble pie for a couple of weeks now, and it's made me think that every trainer should try this at least once. Anyone in any field, really; stepping under someone's tutelage can go a long way. But please... humble. Don't be "the trainer'; drop your pro role and play the student. Bobby and the others know I work at another gym, but I rarely play this side. I did, however, mention my deadlift PR when asked, and this was forever held against me. Think a class of four women and one man, and guess who had to lift the same weight as the man?

And if you haven't guessed yet from all the gymnastics, let me make clear that I'm at a CrossFit gym. Did you flinch? Hater, be humble: drop your preconceptions on this exercise phenomenon and see what you can learn. I found myself dipping on rings, standing on my hands, and doing more deadlifts in seven minutes than I'd usually do in a hour. If you're at a solid gym, as I am, you've got something to learn. Those CrossFit injuries you read about come when people--or staff--aren't training smart. I am; Bobby makes sure of this.

...respect your skill set. All those nice comments aside, CrossFit programming demands quite a vast array of skills. I can stand on my hands, but walk? Cartwheel? Not yet, and maybe not ever. But I'm there to try, and later, to pick and choose which new skills I want to work on. I have no plans to compete in their games, so I will work on what's important and what I have time for. Planches are on the list, as you'll see in a minute. And I know I need to work on endurance and conditioning, which happens by default when I show up. But I don't need to be laid out for six weeks with an injury, so sometimes, despite that first paragraph, a no is a no.

And finally...

...step into your client's shoes. Found along the path of humility is a sense of what I ask of my clients. Those times when I bless them with a nuanced assessment of their mobility issues? They thought this: "I suck." I know this because I've now been there. Bobby knows I want all the facts, though, so he gives them to me; but with the general public, I realize, I need to keep things positive and challenging, minus the helplessness that can come with realizing, say, your right foot likes to turn out every time you squat deep. Point is, by being a student for a time, I can become a better teacher.

I'll head back to the gym later this week for another sweatfest and dose of reality. Meanwhile, in keeping with the humble theme, I present one of my many recent fails. But look out, straddle planche: some day, after much effort, you're mine.


Monday, July 14, 2014

End of June Project

Some of you have said that my June Project, now complete, inspired other creative ideas on how to teach the discipline of showing up.

That's the point. Of this blog. (To get you thinking.) But it's really wonderful when I actually hear about these things rather that y'all just stalking around.

And it was really great to watch this idea succeed right here at my house. Spoiler alert: both kids are still keeping up with their projects, though it's now July and no schedule is enforced. Simon is reading and blogging away, and you really should stop over there, comment, and make his day. Theo continues to write, though, true to his nature, a hundred new ideas have sidestepped him. That's okay; the drawings he's producing are worth the segue. I put my reading on somatic psychotherapy to the side for a time, though I did manage to strike up an email conversation with the author of the book I studied. Later, I found out that this is a pretty big deal, as she's well-known in the field. It pays to be naive and curious.

The June Project was three weeks of showing up for a half hour each day to work on a project of our choosing. We needed a ceremonial finish to such good and solid work, so on June 29, we gathered in the living room and made presentations to each other. Possibly we wore pajamas, though I'd like to think I tried to make this event seem worthy of clothes. Simon and I took turns describing our projects and what we learned, and Theo read an excerpt from his writing. (Somehow I managed to tear up while reporting on the amazing things I had learned.) I then took the opportunity to review what I hoped everyone had learned by doing: that sometimes showing up means staring out the window or picking your nose for a bit; that sometimes you have to throw away a day or two's worth of work, but you need to clear that out of you before the good stuff could break through. And finally, that perseverance pays off, and is even a little addicting. Thank you, June Project, for rewarding your apprentices.

Tuesday, July 8, 2014

Pump Class, Advanced

Extended bolus, square waves, IOB... today's pump class was a vocabulary lesson, somewhat of a review and yet revelatory, too, as we've been with pump for just over a month. Life with the t:slim is comfortable enough for Theo to program in a meal with one hand--the other holding down the page of a book he's caught up in--and yet breathtakingly stunning on a regular basis, like the saturated red of a sunset on Lake Michigan. The decimal points astound me daily; the pump, unlike injections, can deliver .0X units of insulin. Previously, meals needed to be rounded up with a goldfish cracker, say, or half an ounce of milk, to meet the insulin pen's half to whole unit requirements, along with scores of mathematical equations. Now, no longer: whatever Theo will eat, the pump will count up, divide and deliver. At any time. And whatever amount he needs to bring down a high, the pump will give, when we ask it to. Like this morning, when I was determined to sleep in: I armed Simon with granola bars, measurements for milk, and permission to approve the pump's calculation to bring down a 172. At 9am, this had fully kicked in, and I, rested for once, could begin breakfast. (In the past, I would have had to get up at the first sign of a low or a high.)

Thank you, Jesus, for the pump.

Our pump class today on advanced features was attended by pump users with varying experiences, from our five weeks to one young man's eight years. A woman attended with her daughter; both have type 1. The room was full of beeping people, I noticed at one point--we're used to regular messages from our little machine, and now here were apparatuses everywhere, making themselves known. The woman and her daughter tested their blood glucose levels as a team. We followed the powerpoint and asked questions. The teacher is a diabetes educator I feel an intimacy with, as she has coached me through complex questions and hard times. She is just the right balance of dry and caring that I need; she's my favorite.

The teen girl behind us was the most talkative, ending most of her serious inquiries with a nervous giggle. Good for her, though, that she's thinking through the effects of her soccer practice, fighting ketones, seeing the trends. At one point when I was writing a note, Theo had raised a hand, and the educator called on him by name without fanfare, though he was the only kid to make his presence known.

"Is it okay to sleep on the infusion site, and the pump?" he asked. God, what a great question, and one that only he knew to ask. She answered affirmatively, noting that kinks could occur, but would make themselves known.

As the class wrapped up, the class became comfortable with speaking up in a way they hadn't before.

The teen girl asked a question.

"Um, yeah, I was wondering? I watch Survivor kind of shows, and I was wondering, like, would I even survive something like that? I mean, it would be really cool, but I would probably, like, die, right?!?!"

Some laughed along with her; to me, the room started spinning. Was this how Theo would be introduced to what the school labels as his disability? That "without the mediating factor of insulin," he would die? it's what gets us special attention at school, but the wording in our 504 plan offers no subtlety.

"Probably you'd only last a short while on a protein-based diet," the educator said, kindly.

"I could scrounge for some berries!" the girl giggled.

Theo looked down. I know this look. He's processing something big, and he doesn't want to talk about it. I didn't ask. Rather, I opened the door in the car: "Any questions?" We marveled at the parallel universe feel of being in a room full of diabetics. It's a bit disconcerting, though I can't exactly figure out why. We drove away and to the grocery store, where they offer free cookies at the bakery counter. 21g, we guessed; Theo entered the numbers, and took a bite.

Thursday, June 19, 2014

June Project: Day 11: Body Awareness

Identifying traumatic triggers is one of the great challenges of trauma therapy. Stimuli from the environment can inadvertently set off a traumatic reaction in a client. Often the client is left with the reaction but has no idea what caused it. Tracing the reaction back to the source, the trigger, can be an important task. To that end, body awareness can be a useful assistant.

---from The Body Remembers, by Babette Rothschild.

In a chapter titled "The Body As Resource," Rothschild tells of a client with chronic hip pain, which had come on a year after her husband's death. Their time together in therapy typically focused on the woman's grief, but one day, in attempt to address the pain, Rothschild employed techniques to develop body awareness. As the woman focussed on her hip pain, her heart rate soared, and she became fearful and anxious. Rothschild asked her to sit with her emotions for a bit, notice them, and as she did so her right foot pressed solidly into the floor.

"It wasn't long before she took a huge breath and began to sob, 'I drove as fast as I could. I floored the accelerator. It was an old car and I just couldn't get it to go faster!'"

The woman's husband had had a heart attack in the car she was driving, and she had been unable to get him to the hospital before he died. The memory showed itself in her gas pedal foot, which ultimately caused her chronic pain.

The body remembers, indeed. But does it also look for its own solutions?

I'd like to flip Rothschild's technique around to ask if we can find other signals to show what the body remembers, or needs. To use myself as an example, I take note of what kind of physical outlet I'm looking for, and when. My exercise preferences lend themselves to the heavy and violent, but I'll save boxing for another post. Weightlifting: I like it. I simply like to pick up heavy things and put them down, as the joke puts it. But there are some days when I need something else. It's a very specific sensory need, and as it happened to come around this week--it doesn't too often--I figured I'd analyze it.

Two of the basic functional movements the body performs include the "push" and the "pull." In brief, push requires the chest and triceps, while pulling asks more of the back and biceps.

I have noticed that this specific feeling I get requires the push. Now, you can achieve the push through any chest exercise, really--bench press, dips, pushups--but those rarely cut it for me, because there is only so much weight I can hold on to and lift. That should be enough--lifting as heavy as I can--but it's not. Somehow, I need to feel the sensation of pushing against something large and virtually unmoveable. Think a car. I have done this, in these times--hauled the family into the car to push it. The other day, when this wasn't possible, I rigged a machine in my Y and pushed more weight than I should have been able to.

Theo had been sitting in the hallway with a blood sugar low. "Theo," I said when I emerged from the room, "I just used a machine in a way that was not intended."

"Did you pick the whole thing up, Mom?" he asked. He's a stinker.

I have to guess that just as memories can surface in the body in specific ways, memories--or needs--ask the body to perform in certain ways, too. My need for "push" is so specific that I have to believe it's telling me something. Am I trying to move a metaphorical obstacle, large and heavy, out of my way? I don't know. But reading Rothschild's work, I have to believe that when the body speaks, it's telling us something.

Wednesday, June 18, 2014

June Project: Day 10: Stress Response

Now I have a name for what I did when a knife was held to my face, and when a man thrashed at my rental car and no one else was around: dissociation.

"It is possible that dissociation is the mind's attempt to flee when flight is not possible," writes Babette Rothschild in The Body Remembers, which, you'll remember, is a book I'm studying throughout the month of June. Fight, flight, or freeze are the autonomic nervous system's responses to perceived threat. Whereas those bunnies I mentioned in an earlier post run when the dogs walk by, the mind, during dissociation, finds its own method of getting away.

The process of dissociation involves a partial or total separation of aspects of the traumatic experience... One person might become anesthetized and feel no pain. Another might cut off feeling emotions. Someone else might lose consciousness or feel as if he had become disembodied. (page 65 in The Body Remembers)

Taken to an extreme, this separation can result in identity disorder. But perhaps worst of all, dissociation can reappear after the traumatic incident, compounding the already debilitating effects of anxiety. Rothschild believes the symptoms of PTSD can likely be traced back to some form of dissociation.

It's the P in PTSD (post-traumatic stress disorder) that's the most disturbing, then. The person has experienced effects such as dissociation during the traumatic incident, and then continues in an unsustainable state of hyperarousal. There is no actual fear stimulus, and yet this constant state of anxiety makes everything seem a threat. Sadly, because their built-in warning systems aren't functioning properly, "it is typical for those with PTSD to repeatedly fall prey to dangerous situations" (page 62).

Back to the knife and the rental car: I shut down. I became calm, and where my male friend ran when he saw the knife, I stayed. In both cases, though I wouldn't recommend this to others, I saw it through and was able to diffuse the situation.

But reading about trauma brings back another memory where my stress response surprised me. You could say that the situation was a safe one, and yet certain aspects triggered memories and, also, fear. The details are personal, but I will describe my response, which was first to plot out an escape route. Think Sherlock Holmes narrating each detail of what he sees: my mind went to each door, and to where my children were, and then, Holmes-like, plotted a route to grab them and get out. This took maybe three seconds.

But then my tongue went numb, so my flight response, I guess, was paralyzed. I sat with my flight plan ready but unable to be executed. I thought it was all the weirdest thing until I started reading Rothschild's books.

Had I completely frozen, which is a real response, one way to recover is to just move a finger, according to Rothschild. Just telling your body that you can actually move helps get it on its way. Body awareness is a big part of recovery, and I'll get into that more tomorrow.

Friday, June 13, 2014

Posture (June Project, Day 6)

And today, the somatic nervous system (SomNS) in brief, again with a focus on psychotherapist Babette Rothschild's writing in order to understand the connections between trauma and exercise. Think of this as the notes I take for myself--an amateur study of one woman's life's work. There's so much more to these concepts than I can flesh out here, but I want to try to grasp the scope of the theories before diving into the part I'm interested in most. (See "june project" label for previous entries.)

"The autonomic nervous system... directs blood flow away from viscera and skin to the muscles for the duration of fight, flight, and freezing responses. The somatic nervous system directs the musculature to carry out that response." page 53 of The Body Remembers.

Rothschild points out that the SomNS operates via neural impulses, making any contraction of muscle an active state. "Relaxation, usually thought of as an active process, 'Hey, just relax,' is actually a passive state." (page 51)

And isn't nothing always the hardest to do? I've always pitied people going cold turkey on cigarettes or substances, because they have no work to be done--rather, the absence of a thing. Their goal is to not do something, with a sense of accomplishment coming from accomplishing nothing. Whew.

To jump, then, to another fascinating bit in her books,: the connection between the SomNS and what Rothschild calls "The mechanism by which traumatic events can be remembered implicitly through the encoding of posture and movement."

Posture. I've undertaken informal studies of this myself, of actors and homeless people acting. Why, if we can become someone else, do we not? Why not act more confident than we are? At least a smidgeon?

"Because it would be exhausting," said a friend of mine, an actor in NYC. But Rothschild has done some fascinating work in this area.

While laying out the idea that increased muscle strength helps clients with PTSD, she speculates that part of the success of this technique may include a protective mechanism. "More tone across your chest or back can help you to feel more protection--armor--between yourself and others," she writes in 8 Keys to Safe Trauma Recovery.

She goes on to tell of a client who would suffer extreme stress at family events that involved a buffet table. The mere act of turning her back to the rest of the room caused such anxiety that she'd hardly eat.

Rothschild experimented: Could she try throwing those shoulders back and standing in a confident stance? This helped, but having her chest exposed didn't. How about shoulder blades together but shoulders curved forward, bracing her chest? It was a stiff and strange posture, both admitted, but it worked. She could make her way through family gatherings without anxiety, though still a bit stiff.

In an article called "Applying the Brakes," Rothschild recalls the phrase "weak in the knees," which speaks to an actual fear response. When a client of hers felt this condition come on, R had her press her feet into the floor. (Reading this, I'm kicking myself for not thinking of this technique for my 89-year-old client. Isometric exercises can be terribly effective, and I've had capable adults "push" the wall or against their own knees to create the same effect.) Once the client felt the strength in her knees, she calmed down. Following a state of hyperarousal due to a rush of stress hormones, her hippocampus could relax and function properly, allowing her to clear her head and make better use of the rest of the therapy session.

Again, I can't see why the average person in a state of stress can't try these posture techniques. I knew I had picked the right person to study when I read in Rothschild's introduction to 8 Keys to Safe Trauma Recovery that her "professional goal is to become obsolete." In her work, Rothschild insists that her clients understand what helps them, so they can call on these tools when needed. I approach my clients in exactly the same way; education is as much a part of an hour with me as exercise. Make no mistake: they get a workout. But my goal is to have them reach a point when they no longer need me, or can break away for a time.

Always learning. Try the posture technique. See what happens, and let me know.

Thursday, June 12, 2014

June Project: Day 5: The Nervous System and Bunnies

It is fitting, perhaps, that today's foray into the workings of the nervous system was interrupted repeatedly with jolts out of the chair. "Bunny!" "Chipmunk!" "Two chipmunks!" Our yard is a veritable zoo, which never ceases to overwhelm us with its cute factor. Even the slimy frog that visits my kitchen window is soooooooo CUTE. But anyway: these times are lessons on how to stay motivated on day 5 of a monthlong project, even when you're not really feeling it.

My study of muscle tension as therapy in Babette Rothschild's work needs to begin with nervous system response, even though I keep flipping to the really fascinating stuff in the book that finally arrived from the UK.

Okay, can't resist. Here's one to tie you over (from page 5 of The Body Remembers):

A woman whose 3-year-old daughter had died four years prior was recalling, in a therapy session, a medical visit that had been particularly challenging. The details eluded her, but as she spoke, Rothschild noticed the woman's head jerking subtly to the right. The woman was unaware of the movement, and R suggested she allow it to develop. "Slowly the movement became bigger, becoming an obvious turn of the head to the right. When her head made its full turn, Carla began to cry."

And then she remembered. At the medical visit in question, an x-ray of her daughter had been displayed to the right, but the woman couldn't bring herself to look at it. The x-ray, and the visit, had made clear that the daughter wouldn't live.

As the title says, The Body Remembers.

This reminds me of the first year following Theo's diagnosis of type 1 diabetes. Each Friday, when I'd visit the school to refill supplies, I'd have to fight back tears. I could say these came out of nowhere, in a sense, because at home, I handled supplies all day long; but of course, the response was deeply-rooted in a type of grief. There were other times, too, when this grief would hit, yet the regular attendance of tears each Friday caught me off guard every time.

Trauma of any sort can manifest itself in physical symptoms, with some of the most dramatic including the freeze response, where a part of the body can go numb, or get stiff and "stuck." Though the trauma may have originated in what feels like an emotional problem--verbal abuse, the death of a loved one--these deep feelings find their way through bodily processes.

We'll focus on just one today: the autonomic nervous system (ANS). When the limbic system of the brain detects a threat, it engages the endocrine system and the ANS in the work of preparing to fight, flee, or, if neither of those can be accomplished, freeze.

"PTSD is characterized, in part, by chronic ANS hyperarousal. The system is always stressed.... When SNS arousal is constantly high, adding a news stress shoots it up even higher... This difficulty is familiar to many with PTSD who wonder why they cannot handle daily stress like everyone else or like they used to be able to." (page 50)

Explains a lot, doesn't it? Of course, this is just an armchair summary of complex processes, but I think it can serve to articulate the situation of people under chronic stress. (And even those bunnies in the yard, who exhibit a type of freeze response when unable to flee.) In future posts, I'll get to what interests me most, which is what Rothschild suggests to be done about it: work those muscles.