Stepping Out
This article was published in a regional magazine of the bodywork professions, Massage Message, and in Trager Talk, the newsletter of the US Trager Association.
Stepping Out
As I prepared to meet Betty for the first time, I reviewed what she had told me on the phone when making the appointment. At the age of 70, she had been through several surgeries on both knees and both shoulders. Her complaint though, was that she was having trouble with balance and couldn’t feel her feet so well any more. She had recently fallen and cracked her sacrum. She also let me know that she loved to dance--loved to go to a Conscious Dance group each week for a chance to engage in freeform, creative, expressive movement—but was troubled that she didn’t trust her feet.
She’d had a really helpful Trager session from one of my students, Ross, up at the massage school in Silver Spring, MD. She saw her therapy clients in another DC suburb a few days a week, but she lived closer to my Charlottesville, VA studio--the hour drive here much preferable to the hour it took in DC traffic just to go from her office to the school for a session with Ross.
Just as I finished reading my notes, I looked up. Through my windows, I saw a large-boned woman with greying blond hair leaning forward on walking sticks, struggling awkwardly up the sidewalk. As she approached, her feet shied away from meeting the ground with each step (a fruitless effort). Her right leg dominated the galumphing gait, her grimace announced the pain she was trying to avoid.
Once inside, she set the sticks aside and leaned rather heavily on the back of a chair as we chatted and discussed her concerns. I asked her to walk a bit so I could assess her gait. She just barely managed one loop around my table without the sticks, clearly uncomfortable with each step.
“OK, take a seat so we can talk.”
She did sit, slowly, gingerly, only perching on the edge of the chair. She confirmed all of what she had told me before, her words and her facial expression revealing her deep fear about falling again. Then I asked her what she had particularly liked about her Trager session.
“It was the gentle movement. I love movement. I love to dance. And I felt so much lighter both during the session and for a day or two afterward. Something clicked for me. I want to give this work a try. I think it might actually help.”
“Well, what I just saw in your walk, as brief as it was,” I began, “is that your head and upper body are getting ahead of your hips, and your weight is falling heavily onto your feet and legs. And your gait is uneven. Why do you think you land so hard on your right foot?”
“In my third knee surgery on that right knee, they restructured the bottom of my femur. Now my right leg is shorter than my left. So when I am standing around, I keep my left leg bent and lean my weight on my right. That way my pelvis isn’t so tilted.”
“And you said you couldn’t feel your feet, is that right?”
She nodded. “Neuropathy set in after that last round of surgeries. I hate that I need these sticks to get around, but better that than risk another fall. My sacrum is never without some pain now, even lying down. And there is nothing they can do for it but wait till the bone knits back together.”
“Wow. That’s a lot for your body to be dealing with. And yet, I see how determined you are to figure out what will help. I’m glad you are here. I’m not a doctor, and can’t rebuild your knees, but as long as you agree to be honest with me about how everything feels as we work---in this work, we back away from even the slightest discomforts that might cause your body to brace further--I imagine I can have some productive conversations with your body and show it how to redistribute the weight more efficiently. Then if you want, I’ll show you what you can do, daily, to keep the realignment process going between sessions. Okay?”
She nodded again. After I helped her onto my table, and positioned a pillow under her knees to make lying on her back more comfortable, I asked if that felt OK. Her nod was not convincing. So I added a second layer and her smile told us both we were on the right track.
“That makes quite a difference. My sacrum doesn’t hurt now.” “Do you sleep with this amount of support under your knees? It takes weight off your sacrum. And it seems your knees prefer being a bit bent anyway.”
As I began to feel my way into contact around her body--fitting my hands to the shape of each place I touched, smoothing length into her arms and legs, easing an increment of width into her waist and hips, sliding my hands up her sides and under her shoulders, sculpting under her neck and head—I maintained part of my attention on a strong connection with the ground through my feet and a clear alignment of my spine with gravity. When she occasionally sighed in relief, I repeated whatever it was that her body had found pleasurable. When she winced in momentary discomfort, I recalibrated my touch.
“Does it feel better if my touch is slower or softer, or if there is more or less elongation here?” I was impressed with how clear she was in reporting her experience and how quickly her experience changed as I changed my touch or intention. With each touch, each movement, and with the many pauses for both of us to notice the way the subtle shifts felt, her body began to trust my hands. Her breath slowed, and her weight relaxed. Her face softened too, and the urgency in her voice lost its edge. She began to be able to simply give me the guidance I needed for this first session.
Before she got on the table, I’d explained to her how much her central nervous system relied on clear and detailed sensory information from her feet in order to balance her body, and I wanted to spend quite a bit of time enlivening the sensation there. But I wouldn’t start working there. I first wanted to bring more sensory awareness to her feet by opening up all the channels of information to and from her spine. I wanted to begin by freeing up any joint or soft tissue compressions that were impinging on the free flow of information in her neural network.
This holistic approach honors the amazing ways our human bodies orchestrate all the wondrous things they are able to do whether we are paying direct attention or not. Our remarkable bodies work best when they are open and joyful and all systems are working well together. So my main goals for her first sessions would be to improve her “interoception”…her body’s awareness and regulation of itself.
Eventually, I did shift to some more specific work directly on her feet. (Well, to be honest, it feels less like work and more like creative play to me.) I caressed the surface to stimulate more “exteroceptive” awareness—awareness of the external environment. I took her feet through the full range of possible movement--movement inherent in the act of balancing--emphasizing the articulations of the tarsal and metatarsal bones and the multidirectional movements of each of the toes. I molded her soft tissue in the way I would work with a lump of clay to prepare it for sculpting. As I worked, I made sure I grounded my own body awareness so her emerging sensory perception could feel the earth through me.
After almost an hour on the table, and a long pause, I helped her up and gave her a chance to sense her new distribution of support in standing. As she took her first few steps, I remarked how her taller carriage allowed her lopsided gait to gain a measure of elegance. I noted that her head was now directly above her pelvis, no longer in front of it, requiring a lot less energy from her body…energy she could use instead for refining her walking gait. As she left my studio, I had to remind her to take her walking sticks with her.
Throughout the first couple of months of weekly sessions, she relaxed more deeply each time. Her entire nervous system gave in to the hypnotic effect of the waves of movement and sensation, and her soft tissue structure spread its inner volume like a bird with fully fluffed feathers. Inside her body, she noticed her freedom of movement increasing, and with it, her overall sense of happiness.
She was also diligent about daily repetition of the body-mind exercises I gave her. Two months into our work, both of us delighted at how upright she carried herself, how much better she was sustaining the new, balanced movement patterns, how much longer the post-session floaty feeling lasted.
On her ninth session she asked me to begin with the work on her feet. She thought it might be important for her to be more conscious of what she felt in her feet as I worked. She explained that the rest of the session was so lovely, she fell into something like a trance, and the bliss of it made it difficult to pay attention to her feet. But at the end of that session, she agreed that what her body really craved was the intense pleasure of her central nervous system releasing its hyper vigilance. So I returned to my intuitive sense that I needed to begin each of these balance-focused sessions on her neck, only coming to her feet when the spine was fully open and listening.
We both wish her shoulder and knee surgeries had been kinder to her body, but we are getting a 50% increase in foot responsiveness, and the work is inspiring. Given her age, I wouldn’t have expected such fast improvement. However, the best reward of all is the look of delight when she jokes that the walking sticks are collecting dust in the closet.