On Saving Knees

In 1997 I realized that I was a mess, in a musculoskeletal sense. I had back pain all the time and scoliosis. 25 years of chiropractic care may have delayed this moment of truth a few years, but not a single one of them (DCs) had a real solution. Not knowing what to do, I vowed to find the solution myself. I sensed that it would be a combination of acupuncture with something else. Looking back on that moment now, with my added years of acupuncture experience, I would still say that acu plus "something else" would be the best course, even though I now have greater faith in needles. I'm writing this in response to this week’s entries about injured knees and backs from leaning and kneeling to treat patients in recliners. I may be able to contribute something to the discussion here because I spent a lot of money and a lot of time learning something called Hanna Somatics, which has been the key to recovery for me.

Acupuncture is terrific, even magical, in releasing contracted muscles. Patients walk in grimacing with each step, and then return for the second visit with a big smile on their faces and comments like "It's amazing! A miracle! You're a genius!" Frequent acupuncture on someone who has recently developed this problem will usually wipe out the problem. Unfortunately, most people wait until they’re in extreme pain before considering an acupuncturist, so we’re usually handed a case that’s been developing for decades. Our needles can give them relief for a while, but the problem usually returns, again and again. With all due respect to a medicine that I love, I think this is where we need to look outside of needles.

This isn’t about acupuncture, but I think it’s good to know something about this theory I’m about to introduce, so that acupunks and patients don’t conclude that acu doesn’t work, after a few weeks of temporary relief and the return of the original condition. It does work. But it can’t force a patient to have good posture overnight. It can’t force a patient to stop worrying and hurrying. It can temporarily put one in a state of peace and relaxation, which does contribute immeasurably to healing. The point here is that acu will get rid of the pain, but as soon as they stand up, the patient may begin putting that pain back in again. I think it’s good to know something about this approach to muscle and joint pain because there are techniques you can throw in, as you needle a patient, that take only a few minutes, and help to develop a better working relationship with the patient. Most importantly, it can help you to withstand the ravages of work that involves bending and kneeling.

In some ways, I think our work is better than desk work because we get more variety in the positions we assume to treat our patients. Sometimes we are standing, sometimes bending, sometimes side bending, or kneeling on one knee, or crouching down. I personally like the variety. With a physical history like mine, you would think that I’m incapable of this kind of movement. But with a combination of acu and H. Somatics, I’ve been able to maintain a fairly normal life.

The secret is awareness of posture. (Those Feldenkrais people really do have something good going. But Somatics, even though a child of Feldenkrais, outshines it in that once you learn the principles of Somatics, you can become independent of the Somatics practitioner and become entirely self-correcting. Other educative therapies aren’t as dedicated to empowering the ordinary client.)

Perhaps some of you know and use similar techniques, but after years of searching through different healing modalities, I am convinced that Somatics is one of the best and safest approaches.

The books I would recommend that you read are Somatics by Thomas Hanna and The Thinking Body by Mabel Todd. The second book may be hard to find, as it is from the 1930’s, I think, and was studied by Hanna.

This is not a quick fix, but it has been known to give immediate pain relief, and it’s far more preferable to surgery. To begin, we need to understand how each muscle is affected by every other muscle in the body, no matter how distant, just as we have learned that not only does one point reach from one end of the body to another, we can duplicate this relationship throughout the entire body by using the imaging system so recently discussed under Nuts and Bolts. Once we understand this, we may be able to accept Hanna’s theory that almost all musculoskeletal problems begin at the waist level, at the lower back, which is almost always the first place in the system to become habitually contracted to the point where we are unable to release those muscles. (Read about the Landau Reflex.) Barring any specific trauma, this is how most of us come to have bad knees, weak ankles, bunions, hammer toes, plantar fasciitis, Achilles tendonitis, etc. The tension and unnaturally maintained contraction in the lower para vertebral muscles influence and eventually contract neighboring muscles (up into the shoulders, down into the hips) and consequently, in a domino effect, the rest of the line of muscles reaching to the extremities. I consistently find that whenever patients complain first about these extremities, they will have tight back muscles. The pain isn’t in the back, it’s somewhere else, but I always find the back tension by testing other parts of the body and inquiring about the history of this patient (accidents, traumas, high-stress lifestyle). A secondary habitual pattern involves the front muscles of the body, resulting in neck, shoulder, elbow, wrist and finger problems. Another story. These are all detailed in the Somatics book.

I am offering this information because I believe that we can beat the idea that our particular style of acupuncture is joint-threatening. Buy and read the Somatics book, then email or call me for ideas on how to incorporate these principles into your practice to save your body. I’m not there to physically guide your movements, or to evaluate your posture, but I’ll do whatever I can over the phone or email. The book is available through Amazon, and can be found used, for an even lower price.

Before I close, may I offer a suggestion to those whose knees bother them from time to time. Catch your knee doing it. When that happens, stop. Take a breath and focus on your pelvis. Swing it forward so that your pubis is pushed forward and your tailbone is dropped. Holding that position, raise your sternal notch and you’ll feel your rib cage rising and your neck changing position. Hold those two new positions and just let your back and shoulder and arm muscles soften. Take another breath and notice what it’s like to stand straighter. Check your lower back and sacrum to make sure they’re relaxed. Your front muscles in your abdomen should be tighter and holding you up, while the hip and back muscles are softer. Then try walking in that position. For some of you, I would expect to find some relief walking that way, be it on level ground or climbing the stairs.

The explanation for this is that if the middle of the body is tight, those large muscles are shorter than normal and unable to fully release during the natural movements of sitting, walking, turning, and running.
If those muscles are locked up, something’s got to give somewhere. Our muscles operate as a true community. If one member has a problem, the others pitch in to help. If the large back muscles aren’t able to lengthen properly, the adjoining muscles take over. Often the knees will assume some of this responsibility. The problem is, knee muscles are small and designed for flexibility. They weren’t designed to do the heavy work of the back muscles. But they will as long as they can. And if there’s no relief for a long time, those knee muscles will tire and weaken and then wear out.

If any of this makes sense to you, and helps any of you, then I may feel that maybe this is a blog worth posting.