AlexanderTechniqueandRehabilitation:acasestudy

StephanieSmith16thOctober2013 FS,femaleaged39 FSisamanagerwithanimportingcompany.SheisfromAustraliaandhasbeenlivingintheUKfor fiveyears.Sheisunmarried,independent,intelligentandresourceful.FSisdeterminedtoplayan activeroleinherrehabilitationafterspinalsurgery. FollowinganMRIonherlumbarspine,itwasdiscoveredthatFShadadiscimpingingaspinalnerve forwhichshehadadiscectomyattheendofJuly.Damagetohernerveswassevereinbothlegs withlossofsensationandshehaddroppedfootsyndromeinherleftleg.TheMRIhadalso revealedthatshehasaprotrudingdiscabovethediscectomythatisseverelyworn. FSfirstcontactedmebyemail17thAprilthisyearwhileshewasinhospitalfor17daysforan epiduralforlumbarpain.Shetoldmethatshehascontinuallegpainandthatshealsohastwo protrudingdiscsinherneckwhichiscausingnumbnessinherrightarm.Shealsoaddedthatshe canhardlywalk.Shetoldmethatshewashopingtobedischargedlaterthatday.Shephonedmea weeklaterandwespokeabouthercondition.Iadvisedherthatitwastooearlyinherrecoveryfor hertostartAlexanderTechniquelessons.Ialsorecommendedabookforhertoread:Explain Pain:DavidButler,LorimerMosely:NOIGroupPublications.
Stephanie provided some great guidance at a time when my morale and general wellbeing was quite run down. In speaking with her I obtained some hope that my condition could be improved and that I may once again have a normal life. Her encouragement and general demeanour was what made me think this practitioner was for me. Being familiar with The Alexander Technique from Australia I thought that this would be the best form of rehabilitationgivenmymedicalcircumstances.

FSphonedmesomemonthslatertosaythatshewasduetohavethesurgicalcorsetremovedand waskeentostartherlessons.Isuggestedthatitwouldbebeneficialtohaveonesessionjustbefore hercorsetwasremovedinorderforhertohaveasenseofstructureandsupport. Firstlesson

25thJuly2013

Ithinkwereinthisforthelongterm.
FSwhenshecameinforherfirstsession

FSwaswalkingwithgreatdifficulty.Shehadnotbeengivenafootbraceatthispoint.Itwasclear thathermobilitywasverylimitedandIdecidedtoimmediatelyplaceheronmyteachingtablein semisupine1inordertobeabletoworkwithher.Usinglighttouch2,IbeganbyteachingFSmental

Supportingthebodyonaflat,firmsurfacealtersthebodysrelationshiptogravityandthehabitualresponseto gravity.Fasciaandmusclescanbeencouragedtoreleasefromingrainedpatternsoftensionandtheshapeofthebody changes. 2 Lighttouchinthiscontextisusedtomeanproprioceptiveguidancewithoutmuscularforce.

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directions3toactivatesupportingandbalancingmechanismsinherbody.Usingthisprocesswould alsohelpFSthinkclearlyaboutherbodyandreestablishcoordination. IfoundthatFSscalfmuscleswereverycontractedinbothlegs.Shehadfootdropinherleftleg andtheheelofherleftleghadlostsensation.Iwasunsurewhetherthiswasduetopermanent damagetonervesorifsensationwouldreturnintime.Withhealingofthethorocolumbarfascia, pullsacrossthefascialnetwoulddecrease.Itwasclearthatlossofsensationfromherleftheelwas affectingherbalance.Therewereanumberofissuestoaddressbutasweonlyhad10sessions,my planforFSsrehabilitationwouldbetomainlyfocusonhermobilitybyimprovinghersenseofher mentalbodymapandprovidingherwithclarityofthoughtforintentionofmovementinorderto stimulatehermechanismsofsupportandbalanceandtocontinuetoencouragereleaseofhercalf musclesandanklejoints.IsuggestedthatsheaskherconsultantforanNHSneurological physiotherapistbutshewaseventuallygivenasportsphysiotherapistattheendofAugust. BytheendofherfirstlessonIthoughtthatFSsmobilityhadslightlyimproved.
When I first walked into Stephanies room for treatment I was hoping that this would be the right move and it was. It was halfway through the lesson that I started to feel things happening; however I couldnt put my finger on what exactly it was. Whilst still in quite an amount of pain I left the lesson feeling more relaxed and positive in attitude. My mobility was improved from day one, as through subtle movements I was able to adjust my posture to take pressureoffmyspine.

Subsequentlessons WearrangedforFStohavearegularappointmentonceaweekfor10weeks.Eachtimeshecame forherappointmenthermobilityhadimproved.Shehadalsofoundandboughtamoreconvenient footbrace.Igraduallyintroducedstagesofmovementsuchasgentleforwardlungestoimprove transferofsupport.Notingthatherbalancewasmoredifficultonherleftfoot,FSusedThe AlexanderTechniquetogiveherselfacontextinwhichtothinkaboutandcontrolherbalance. Towardstheendofher10sessionsIintroducedsegmentalturning/spirallingmovementsstarting fromtheeyestoturntheheadthenshouldersandhipsgraduallytransferringsupportandbalance tothehomolateralfootwhilemaintainingherfullheightandnotcollapsinginstature.Using thoughtanddirection3,FSsbalanceonherleftfootbegantoimprove. Ninthlesson AsFSsbalancehadimproved,Icontinuedwiththespiralmovementsandthenaskedhertotakea stepwhilemaintainingherposturallength.Shewasabletodothiswithoutcollapsinginstatureor losingbalance.Attheendofthesessionshewaswalkingverywell.
FromthemomentIhadmyfirstlessonIknewthatthiswasthepracticeforme.Overthenext eight sessions my range of movement increased, whilst the energy and movement required to do these reduced. My walking improved dramatically, as I had started to walk around my own housewithoutphysicalaids.IfeltlikeIwaswalkingonacloudasmylimbsnolongerfeltheavy
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Thesendingofmessagesfromthemindtothefasciaandmuscletobringaboutselforganisation.

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orpainfultomove.ForthefirsttimesincemyoperationIfeltgracefulandwastotallysurprised athowfarIhadcome.

Tenthlesson

26thSeptember2013

IwasdelightedtoseeFSwalkinwithoutanytraceofherheavylimp.Shewaswalkingwithoutthe aidofherwalkingstickandwasconfidentenoughtowalkfromthetaxiwithoutherfootbrace.We practisedwalkingandIgaveFSsometechniquesincludinguseofhereyestohelpmaintainaneven gaitandbalancewhilewalkingsothatshewouldnotreverttolimpingwhenshebecametired. DuringthispracticeFSsaidthatshefeltasthoughshewasheeltoeing.Attheendofthesession shewasabletowalktohertaxilookingveryconfidentandwithoutatraceofalimp. Ihad10sessionsinallwithFSassheneededtogetbacktowork,whichmadeitdifficultforherto seeme.ForFStocontinuewiththepronouncedlimpandheavyrelianceonherwoodenwalking stickwouldhaveimpactedonthetwoprotrudingdiscsinherneck.ThereforeIconsidereditof primaryimportancetoimproveFSswalkingpatterns.Thelimitednumberofsessionsmeantthat therewasinsufficienttimeformetofullyfocusonherarmproblemsortoshowherhowtoavoid futureinjurytootherareasofherspine.FSsneckbenefittedgreatlyfromherAlexanderTechnique lessonsandshereportedthatitfeltlesscompactedandmorefluid.Therewasalsosomerelieffrom thenumbnessofherarm. FSsrehabilitationhasbeenremarkable.Eventhroughoutherperiodsofdoubtanddifficulty(of which,understandably,therewereafew)shethoughtaboutandpractisedallIhadtaughther.The AlexanderTechniquehelpedreeducatethewayFScoordinateshermusclestopreventtightening. Usingverbalcues,lighttouch4andsimpleprocedureshavebeeninvaluableforchangingthestress loadsonherskeletonandfascia. Whenshecameforherfirstlessonshejokedthatweareinthisforthelongterm.Shemaynot haverealisedthatTheAlexanderTechniquewillgiveherlongtermconstantreferenceand backdroptoherthinking. Inanemailshewrote:
Thank you so much for all your support, care and understanding this year. Please do not think that this is the end of the road. If anything it's just the beginning. AT is now becoming a well tuned cog in my wheel of life! Without you I cant imagine how my recovery would have gone asyoureallysavedtheday.Kindregardsfromthegirlyoutaughttowalkagain.
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Proprioceptiveguidancewithoutmuscularforce.Seepage1footnote2.

FrederickMatthiasAlexander(18691955)developedvocalproblemsasayoungactorinAustralia.Hisprocessofself observationandexperimentationwhichledtoimprovementsinhisoverallhealthiswelldocumented. StephanieSmith,5thDecember2013 TheydonBois,Epping,Essex

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