Day 2: Guarding, Deconditioning, Sleeping, and Stress: Scheduling Matters
My schedule today consists of introduction to physical therapy (PT), introduction to occupational therapy (OT) and body mechanics, psychology group, relaxation group, Feldenkrais, introduction to conditioning, and conditioning at the local gym.
Just a short aside about Feldenkrais: Many, many years ago when my condition was new and only involved the cervical spine, a therapist I was seeing advised me to join a Feldenkrais group. It was something he had just been introduced to and he was excited about the results that people were observing with the method. I was working full time, had a newborn baby, was going to PT, seeing a therapist (because you go to address a problem or to enhance your life!), and running two households. Week after week, the therapist would ask if I had gone to Feldenkrais and week after week, I would tell him that I was doing as much as I could to keep a life-pain balance and just did not have the time for Feldenkrais. After about four (4) weeks of this, I was so annoyed with him that I stopped going to see him, too. I had tried to explain that his insistence despite my protestations reminded me of being forced to do things against my will and it did not feel good or right. His failure to get it or hear me was what drove me away. Who wants a therapist who is insensitive to one’s pleas? In retrospect, we might have been able to work through it if he had addressed my feelings—but he kept holding his position. Anyway, when I saw Feldenkrais on the schedule, I thought, “Finally, I get to try this to see if it can help me.” After the first day all I can say is that I don’t get it, but I will reserve judgment until after the third session. It is as my son taught me with sushi: “Try it three times before you give up on it.” As it turned out, the third time was the charm for sushi and I found myself craving it afterwards.
The big concept for the day was understanding the source of pain accelerants: guarding, deconditioning, sleep deprivation, and stress.
Guarding: (gärˑ·ding), n 1. phenomenon in which muscles react to an injury to a joint, bone or ligament by contracting in order to form a protective splint. 2. a sign detected during physical pain whereby the patient involuntarily contracts muscles second to pain 3. a spasm of muscles that minimizes the motion or agitation of sites that are affected by injury or disease.
Simply put, the contraction of the muscles increases tension in the muscles and the tension causes pain. I have a big mass of tension in my upper back and tend to keep my shoulders raised. This creates upper back pain, spasm, and twisting around the cervical spine because there is more tension on the left than right. I am working to keep my shoulders down and achieve alignment of my cervical spine through relaxation. Often, this leads to headaches. I am fortunate in that I do not get headaches!
De-conditioning: conditioning [kon-dish´un-ing] in physical medicine, improvement of physical health by a program of exercises; called also physical conditioning, so, de-conditioning is the loss of physical health due to lack of exercise.
Simply put, I have had pain when I stand more than 3-5 minutes, so I have found it hard to work out over the past year. Perhaps I could have done chair aerobics or chair yoga but I have not felt motivated to move for fear of re-injury and having had pain as a deterrent to movement. I have also been sad and unmotivated; every day it is a simple challenge to get out of bed, shower, and get dressed. But, the cure for de-conditioning is conditioning. When increasing the physical demands on my body, I am told, it is normal to feel these demands in the way of increased soreness. I am encouraged to work through this discomfort to gain endurance, balance, strength, and overall functional ability.
Sleeping: While sleep is a natural process, it is not always easy to get and takes work to get into a rhythm where we fall asleep easily, if awakened return to sleep readily, and wake up feeling rested.
Pain is a common cause of insomnia; sleep loss increases the experience of pain; and a lack of sleep leads to a deficiency of production of a hormone that helps with tissue repair (Somatamedin C). I have found it hard to fall asleep most of my adult life so I already have a very involved sleep hygiene program that I use and employ at Two Dreams. This has not been a major concern of mine unless my pain is soaring!
This is a short description of the Two Dreams Sleep Hygiene Program:
- Create a switch from sleep (GABA state) to the aware state (Glutmate receptors) by facing the sunrise for 30 minutes every morning. Bathing the retina through the eyelids with sunlight causes the switch in our brains to flip and we have the energy to face the day.
- Taking a power nap before 4 pm, no more than 20 minutes of sleep that follows a shot of caffeine (which peaks by the time the nap is over, giving us the energy to face the rest of the day)
- No caffeine after 2 pm, if at all. I tend to drink de-caffeinated beverages so that I can use caffeine for its stimulant effect when needed.
- No electronic devices after 8 pm. No digital clock, electronic equipment or chargers, no TV, etc. in the bedroom.
- No meals after 8 pm, unless you suffer from hypoglycemia mid-night awakening—then only a small bite before bedtime.
- A hot shower, hot bath, or hot tub soak for 30 minutes right before bedtime.
- A cool room, light covers, and warm fluffy socks to keep the feet warm. (Cold feet are a major cause of mid-night awakening.)
- The program also allows for sleep deprivation in extreme cases. Suffice it to say, if you only get a few hours of sleep a few nights in a row you will start to fall asleep as soon as your head hits the pillow. If the program does not work, and other causes of insomnia and mid-night awakening have been ruled out (pain, depression, etc.), then sleep aids that promote stage 4 sleep can be added. We avoid agents that produce dependence and disrupt sleep.
Stress: Stress is defined as an organism’s total response to an environmental condition or stimulus, also known as a stressor. Stress typically describes a negative condition that can have an impact on an organism’s mental and physical well-being.
Pain alone becomes the stressor. The loss of function and participation in normal activities, the inability to predict when I can be relied upon and when I cannot—all increase my stress and lead to distress. Until this program I thought I was managing my stress!
The intersection of pain, guarding, de-conditioning, sleep deprivation, and stress is more complicated to negotiate than Chicago’s Six Corners intersection.
So what about scheduling? We had a last minute scheduling snafu that caused a big, big blow up in the cohort. The take-home message to me is that, as a patient in the program, I have little control over anything so we focus on the smallest of things. Note to Sid: keep the schedule as consistent as you can and everyone at Two Dreams will be happier.