Moving toward pain relief

A recent pilot study was done in Hong Kong that looks at how Ai Chi affects subjects with knee osteoarthritis, which was published in the Journal of Physical Therapy Science. Following just five weeks of bi-weekly Ai Chi classes, subjects reported significant decreases in chronic knee pain and knee stiffness and improved daily task performance. Why would doing Ai Chi have this effect?

Just being in warm water relaxes muscles and soft tissue. Knee joint temperature receptors block the signals from pain receptors. And the hydrostatic pressure of the water improves circulation to reduce joint swelling and pain. At shoulder depth, the water’s buoyancy unloads the lower limb joints by 90%, significantly lessening the pressure on the damaged knee joint.

But when my friends who spend nearly every weekday in a warm water pool joined me in Ai Chi, they reported relief of chronic knee pain for the remainder of the day that they had not experienced before. Something more was happening…

The diaphragmatic breathing that is a part of doing Ai Chi stimulates the parasympathetic “rest and digest” nervous system, enhancing relaxation. This is the type of breathing I used during childbirth to lessen pain, as a part of a battery of Lamaze techniques. Enhancing relaxation sets the foundation for another important component of Ai Chi: movement. The researchers in the Chinese study point out that Ai Chi involves a wide range of increasingly more complex movements on a diminishing base of support and uses both closed and open chain patterns and weight shifting, which place varying demands on muscles. These are progressive movements with constantly changing variables. Movement is important to normal joint function, and the water creates a comfortable environment to move in ways that are often painful outside of the water. As one of my group participants commented, “I finally felt like I was moving normally.” While doing Ai Chi cannot repair joint damage, it can allow for pain curbing movement in the water.

This pilot study supports the pain relieving effects of Ai Chi that I have seen anecdotally, but it only provides a preliminary look. It opens the door for future studies to substantiate these early results that include more participants and a non-Ai Chi performing comparison group.

You must take the first step. The first steps will take some effort, maybe pain. But after that, everything that has to be done is real-life movement.  Ben Stein

Natural effects

As I walked my dog down a busy urban street today I took special care to attend to the patterns and features of nature around me. I noticed the curve of tree branches, the bushes covered in bright blooms and the chirping birds as we walked. It was a lovely and very interesting walk, but I was not feeling relaxed. A jogger called out that she wanted to pass me causing me to rein in my dog and step to the side. Car horns blared and an ambulance siren sounded abruptly. My cell phone alerted me to an incoming call from yet another telemarketer. It was hard to give full attention to the sensory input from nature. Florence Williams describes a similar experience in her book, The Nature Fix. One summer she decided to use a portable EEG device to find environments that produce alpha waves. Not surprisingly, she repeatedly found that places filled with excessive noise and interruptions, actively trying not to be distracted and feeling angry all inhibited alpha wave production, those brain waves that indicate an alert, relaxed state. To really benefit from being in nature we need to unplug and retreat from society’s distractions.

But even in imperfect environments, nature affects us. Frances Kuo, a psychologist who heads the University of Illinois Landscape and Human Health Laboratory did seminal research comparing levels of psychological aggression and violence in women in a Chicago housing project apartment building. One group had a view of an asphalt parking lot out their windows and the other group lived in apartments facing lawns and trees. Through this research and subsequent studies evidence shows that just living in a place with a view of nature correlates with better impulse control, resistance to distraction, delayed gratification and lower violence, aggression and crime.

What is it about nature that brings calm? It may boil down to the influence of viewing fractal patterns. Benoit Mandelbrot introduced the term “fractals” and the idea of fractal geometry in the 1970’s. Unlike straight-forward, predictable linear geometry, fractal geometry involves systems that change radically due to a myriad of internal and external influences~ and fractal patterns that result from this complex and chaotic system are found repeatedly in nature. The diminishing patterns of a snowflake represent fractals. A head of cauliflower with smaller repeating versions of the whole appearing at each branch exemplifies fractals. The lines of a tree trunk, its branches, its smaller limbs and the striations of its leaves are fractals~ a pattern that appears over and over in different dimensions, sometimes unpredictably inverted or altered due to some intrusion of time or force. British information engineer and internet social scientist George Dallas gives a clear and thorough explanation of fractals in his blog “What are fractals and why should I care?”

Fractals represent an aesthetic order through haphazard grouping, which has the effect of being a very pleasing and sometimes even a spiritual experience for most people. NASA recognized this and funded early work on fractals to create a relaxing environment in space stations without using images that made astronauts homesick. Their studies showed that low to mid-range fractal ratios of large to small pattern repetition increased production of frontal lobe alpha waves in viewers. Mid-range fractal patterns activated parts of the brain responsible for visual processing, for spatial long-term memory and most interestingly an area of the brain which regulates emotions and also is active when listening to music.

As you do Ai Chi, take in the fractal patterns around you- in your surroundings and as you move your arms through the water.

Your deepest roots are in nature. No matter who you are, where you live, or what kind of life you lead, you remain irrevocably linked with the rest of creation. Charles Cook

 

 

For the 99 percent of the time we’ve been on Earth, we were hunter and gatherers, our lives dependent on knowing the fine, small details of our world. Deep inside, we still have a longing to be reconnected with the nature that shaped our imagination, our language, our song and dance, our sense of the divine.

Janine M. Benyus

We’ve only just begun…

Last month marked a celebration of landmark birthdays for the “father” and “mother” of Ai Chi at the 2017 ATRI Spring National Aquatic Therapy Conference, Sanibel Harbour Marriott Resort. Jun Kono and Ruth Sova both turned 70 this year. What a delightful international gathering highlighting Jun’s mantra, “However it turns out is how it was meant to be.” We did Ai Chi with a Puerto Rican dazzle and Ai Chi with a southern twang. We gracefully followed Ai Chi Russian ballet moves and learned about clinical applications of Ai Chi in China. Ruth presented progressions of traditional Ai Chi and Jun shared the healing evolution of his original practice to Ai Chi Zen in response to the 2011 tsunami. And all the while the restorative beauty of palm trees and pelicans, dolphins and osprey surrounded us.

Happy birthday, Ruth and Jun!

Thank you for your gifts to the world.  You have made this world a little calmer, a little less stressed and a little more peaceful, which means so very much. Just look at what you have started!

 

 

Perhaps this is the most important thing for me to take back from beach living: simply the memory that each cycle of the tide is valid; each cycle of the wave is valid; each cycle of a relationship is valid.

Anne Morrow Lindbergh
Gift from the Sea

Immersed in Nature

Shinrin Yoku is the Japanese practice of walking through the woods and experiencing the natural setting with intent through all 5 senses. This practice became an organized movement in Japan in the 1980’s and Japan now has 60 dedicated “forest therapy” trails. In English Shinrin Yoku means “forest bathing.” Promoters of Shinrin Yoku suggest regular slow walks in the woods while breathing deeply and paying attention to the colors and patterns of the forest, the sounds of birds, the smells of plant life releases, the feel of tree textures and the taste of plants; (n.b. the promise I made to my grandfather never to eat plants he did not approve as safe will probably limit me from tastes in nature, as he is not here to ask…)

The Japanese government has prioritized study of the affects of nature on the human body. Studies headed by Qing Li, associated professor at the Nippon Medical School in Tokyo and president of the Japanese Society of Forest Medicine have shown that this focused forest walking experience has calming, parasympathetic nervous system affects, lowers blood pressure and stress hormone production and boosts the immune system when compared with city walking.

I like being surrounded by nature and have always enjoyed getaways to state or national parks for hikes. My dog walks often lead to lake or ocean beaches. Qing Li advises that you don’t have to be walking all of the time during Shinrin Yoku, but movement is an essential part of the experience. He sometimes stops to do T’ai Chi on his forest journeys. I like the descriptive term forest bathing, which brings thoughts of water. Slowly moving through the Ai Chi steps in a natural water setting brings the positive affects of Shinrin Yoku and Ai Chi together. And you don’t actually have to be in a forest to bathe in nature; you may find yourself in a pool in the desolate beauty of the desert or in a tropical paradise. Breathe deeply, notice the colors and patterns and smells and sounds around you and suck on kava infused candy. And enjoy Ai Chi.

A Gift from the Sea

Ann Morrow Lindbergh, wife of the renowned pilot Charles Lindbergh, led a roller coaster life of accentuated by fame, loss, love and betrayal. She retreated to a yellow cottage on the island of Captiva, FL~ a place of calm and healing, and she penned an inspirational book of her insights entitled A Gift from the Sea. This little book has brought connection, empowerment, comfort and calm to its readers for generations since its 1955 publication. Ann Morrow Lindbergh loved being by the ocean. I think she would have appreciated the Gift of Ai Chi…

“The sea does not reward those who are too anxious, too greedy, or too impatient. To dig for treasures shows not only impatience and greed, but lack of faith. Patience, patience, patience, is what the sea teaches. Patience and faith. One should lie empty, open , choiceless as a beach- waiting for a gift from the sea.”

“I am very fond of the oyster shell. It is humble and awkward and ugly. It is slate-colored and unsymmetrical. Its form is not primarily beautiful but functional. I make fun of its knobbiness. Sometimes I resent its burdens and excrescences. But its tireless adaptability and tenacity draw my astonished admiration and sometimes even my tears. And it is comfortable in its familiarity, its homeliness, like old garden gloves which have molded themselves perfectly to the shape of a hand. I do not like to put it down. I will not want to leave it.”

“And then, some morning in the second week, the mind wakes, comes to life again. Not in a city sense—no—but beach-wise. It begins to drift, to play, to turn over in gentle careless rolls like those lazy waves on the beach. One never knows what chance treasures these easy unconscious rollers may toss up, on the smooth white sand of the conscious mind; what perfectly rounded stone, what rare shell from the ocean floor. Perhaps a channeled whelk, a moon shell, or even an argonaut.”

“I walked far down the beach, soothed by the rhythm of the waves, the sun on my bare back and legs, the wind and mist from the spray on my hair.”

“At whatever point one opens Gift from the Sea, to any chapter or page, the author’s words offer a chance to breathe and to live more slowly. The book makes it possible to quiet down and rest in the present, no matter what the circumstances may be. Just to read it—a little of it or in its entirety—is to exist for a while in a different and more peaceful tempo. Even the sway and flow of language and cadence seem to me to make reference to the easy, inevitable movements of the sea.”

Where do I start?

Many Ai Chi instructors begin their classes with an experiential approach, interspersing details about what they are doing and why strategically as they discover Ai Chi together. The participants start in the water and the class begins by following the cues and movements of the teacher without much ado. I can appreciate that everyone has their own Ai Chi experience and “however it comes out, is how it was meant to be.” However, I tend toward a more pragmatic approach. I’m not a particularly “touchy-feely” kind of person (although I always appreciate a sincere hug!) and as a physical therapist I find myself presenting Ai Chi from a basically clinical perspective.

I start my first Ai Chi classes with about 15 minutes on land. I introduce myself, explain what Ai Chi is and the goals of Ai Chi practice. I give a bit of information about the history of Ai Chi and the contributions of Jun Konno and Ruth Sova. And I discuss balance on many levels, including how Ai Chi affects the balance of the sympathetic and parasympathetic nervous systems.

Next I introduce the different types of breathing, and we practice doing diaphragmatic breathing. I explain that Ai Chi should not be a painful experience, and talk about the effects of shoulder-depth water on joints and what participants can do if do too much and experience discomfort.

Finally we talk about core muscle strengthening and practice the posture used in the first 5 Ai Chi steps. I give a general overview of the Ai Chi movements and a final reminder: Remember, one of the primary goals of Ai Chi is to relieve stress, and “However it comes out is how it was meant to be.” I will give you verbal cues and demonstrations, but whenever you breathe or whichever direction you move is okay.”

The participants then get into the water and we start with 5 to 7 repetitions of movements 1-5 then 5-1, giving special attention to form and breathing. I teach from the pool deck, cuing for performance and naming each movement as we do it. Depending on how the class responds, I will move on to another round including more steps consecutively, always concluding with 5-1.

Some of the steps can be confusing, especially when the class is mirroring me, so I use pool area landmarks or body position to explain movements, (“Pivot toward the lap pool” or “Stretch the arm on your forward leg side behind you.”) As time and circumstances allow, I will introduce adding music to our practice and go through the sequence again with Ai Chi Synchrony playing. I gauge the number of repetitions we do based on available time.

To close, I thank the participants for sharing Ai Chi with me, remind them of our upcoming schedule and provide them with a laminated sheet with the basic Ai Chi steps so that they can practice on their own.

Often new members join our group at future sessions, so I review diaphragmatic breathing and the core posture used in the first 5 steps, and provide the new arrivals with a short laminated sheet explaining the basics that they can read later. I always reiterate that Ai Chi should not be painful and however it comes out is how it was meant to be. I decrease the amount of cuing over time and change the music to give variety. I watch the expressions and form of the participants to provide extra cues, encouragement or praise.

As the class becomes comfortable, participants often share which music and movements they like the best or least, and why. If one movement is particularly confusing or difficult, I will review it and we will practice it separately. And if a movement is too difficult or continues to produce anxiety, all or some of us may do fewer repetitions or skip it altogether.

In a world where stress runs high, it is a joy to share Ai Chi.

I just want to get into the water…

A group of older ladies meet in the warm water pool every week at the same time on Tuesdays, Thursdays and Fridays. They are all post-therapy patients who are not quite up to the rigorous aqua aerobic classes that the club offers, but they no longer meet 3rd party payer requirements to work with an aquatic physical therapist. And while many have forgotten the exercise routines that their therapists recommended, they are still drawn to the water. A couple of them walk laps, a few bob on noodles as they scissor their legs, and some just hold onto the wall and chat. By all appearances, this is just another social support group. But why meet in the water?

When you immerse yourself in water, the pressure produced by gravity in the water (hydrostatic pressure) provides resistance to the diaphragm from all sides, strengthening this important muscle for breathing. Resting heart rate decreases and you burn more calories. The tissues around the joints relax when underwater and joint pressure lessens. The heat of warm water helps muscles relax and relieves pain.

And add exercise and movement~ and the benefits multiply. Studies show that obese women burned 35% more fat calories exercising in the water than on land. Hydrostatic pressure offsets lower body swelling that sometimes comes along with exercise. The relaxation of muscles allows you to stretch further than you can on land. The water resistance as you move through the water challenges core and extremity muscle strength, balance and endurance. With the decreased effects of gravity in the water, muscle fatigue is postponed and you can exercise more efficiently. At shoulder level, 80% of the effects of gravity are relieved, so even someone with lower extremity joint problems or weight bearing limitations can enjoy the benefits of water. What better place to be?

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The wild card~ personal music preference

Studies have defined objective traits of relaxing music, but the final component that can make or break stress reduction in an individual is subjective~ whether or not the person “likes” the music.

Not surprisingly, some of the information on the area of personal preference comes from marketing research~ research done with the intent of creating a feeling or emotional connection to commercial brands or products. Whether or not individual marketing researchers follow strict scientific method which can be applied to a general population is unknown~ they are not bound by the same stringent standards as scientific researchers. These standards include assurance that the researcher seeks to be objective and neutral, that the study can be replicated, that the study participants accurately represent the target population, and that the research is done in such a way that it is considered valid by statistical analysis, using equipment that provides accurate and reliable results. Companies spend billions of dollars to reap the benefits of accurate research, but because the studies are proprietary they are not available for public interpretation.

A British marketing research company headed by a neuropsychologist called Mindlab measures responses to target areas through numerous tools and measures. They collect data on brain waves, facial muscle contraction, skin moisture, heart rate and heart rate variances to learn about attention, positive motivation, emotion, cognitive load, and sympathetic and parasympathetic responses. Using this data they develop presentations that promote desired associations in most people. This is the strategy that went into developing “the world’s most relaxing song,” Weightless by Marconi Union. Listening to this music reportedly reduces anxiety by 65% and reduces physiological resting rates by 35%. A 10-hour recording of this music is available on youtube.com. I may be in the minority, but the problem for me is that I don’t like this music. Regardless of the research, it is highly unlikely that I would listen to it.

What kind of relaxing music do I turn to for Ai Chi? The first year I practiced Ai Chi I did so solely to Jun Kono’s Ai Chi Synchrony, imbedding strong relaxing associations for me. The second year I started looking for variety, and I turned to some of my old favorites. Music affects many parts of our minds, including the amygdala, which is linked to emotion and memory. I learned to play the acoustic guitar in my early teenage years and spent many hours playing both alone and with friends. Playing the guitar helped me center during this often turbulent stage of change and transition. And later as an adult when I drove between workplace sites, I found myself tuning to the Coffee House Sirius XM radio station, especially on stressful days. This music that helped me center during my formative years has continued to lift my spirits throughout my life. So my relaxing music list includes acoustic guitar music.

I love to travel and explore new places and different cultures. On a trip to South America my husband and I discovered the haunting sounds of Incan panpipes as we explored Incan ruins. And later on a family trip through the four corners area our son purchased a wooden flute. Shortly after we dispersed to explore an Indian pueblo, the unexpected soothing sounds of his flute echoed through the clay dwellings and we found him playing in a small, ancient room. These special memories put panpipe and Native American flute music on my relaxing list.

The analytical approach can only go so far~ in the end, relaxing music is personal, and stress-reduction starts with a relaxed leader. I like different music on different days. And as an Ai Chi instructor, I share a variety of relaxing music that I like with my classes, and make choices within my own library of music based on their responses. There is no “one size fits all” music.

Finding flow

While slow music tempo is identified with relaxing music, studies also show that participants perceive music with a low volume and a small range of tones as most calming~ in other words, music that is consistent, without any surprises or sudden distractions. Parents across the ages have found that a quiet lullaby has an amazingly calming affect on a crying baby. Even at a faster tempo, consistent music brings calm that can inspire the experience of flow, a concept that Katrien Lemahieu highlights in the faster paced Ai Chi in 3.

What is flow? It is becoming completely engaged in and enjoying the process of doing something in the present moment. Flow is not specific to any one type of activity~ it may be experienced by artists, writers, dancers, runners, swimmers, surgeons, rock climbers, those who play games and musicians as they focus on, perform and enjoy an appropriately challenging activity that they have mastered. It is being “in the zone” for runners and “finding pace” for swimmers. In fact, flow can be experienced in everyday activities that you feel good about~ driving a car, sweeping a floor, ironing clothes, putting away dishes… When you are in flow, what you are doing and awareness of your surroundings merge and even a sense of time may be lost with this intensely positive focus.

But flow hangs in a delicate balance. It is threatened by the intrusion of challenges that exceed your abilities and in not being challenged enough. If I am trying to do Ai Chi in the ocean where an unrelenting strong tide challenges my ability to maintain my balance, I become anxious, stressed and flow is lost. On the other hand, if I do a dozen repetitions of each Ai Chi step I may feel relaxed at first, but boredom may creep in, causing my mind to wander as I lose the anticipation of moving through the dance of Ai Chi~ again, flow is lost.

You are rewarded when you find flow~ there is a sense of balance in giving full attention to something you like, that is challenging and that you know you can do. Thoughts, feelings, desires and complex activity all come together. And studies show that finding flow in one genre can help empower an individual to deal with other potentially stressful or challenging areas of life.

I love the calm and consistency of the topically titled “River Flows In You” by Lindsey Stirling… This music opens the door to finding flow for me.

And the beat goes on…

Music played at 60-80 beats per minute is perceived as most relaxing. Why? The answer may be in a phenomenon called entrainment, the interaction between independent rhythmic processes, such as a musical beat and unregulated heart rate or brain wave frequency.

Christiann Huygens, the 17th century Dutch physicist who invented the pendulum clock, first brought recognition of entrainment to the modern world. Huygens observed that regardless of when they started, the pendulum movement rate of free-swinging pendulum clocks on the same wall synchronized over time. Entrainment has been observed in fireflies that flicker simultaneously, the resetting of body clocks with sunlight changes (circadian rhythm) and in inanimate machine operations. It has been hypothesized that wave interactions cause entrainment synchronization. In the case of listening to music (sound waves entering our bodies through our auditory system), heart rate will move to match ongoing music tempos that we hear, over time. 60 to 80 beats per minute is a calming rate~ a resting heart rate goal for relaxation. And listening to music at this tempo can cause the heart rate move toward the rate of the music.

The sympathetic and parasympathetic nervous systems control heart rate. The rest and digest parasympathetic nervous system correlates with relaxation and a slow heart rate, and the fight or flight sympathetic nervous system relates to excitation and a faster heart rate. Entraining to a slower tempo of 60 to 80 beat per minute relies on parasympathetic nervous system control and can promote relaxation.

But there is more… There are other rhythms going on in our bodies. Neurologists measure brainwaves with EEG studies, and scientists classify brain waves by their output frequency. Alpha waves are defined as waves measured at 8-13 Hz and are indicative of a relaxed mental state~ when a person is awake but relaxed with eyes closed. Alpha wave activity in the occipital lobe of the brain goes along with a relaxed mental state and low arousal. Beta waves measure 13-30 Hz and are associated with a conscious and more attentive state, with eyes open. And faster paced, more activating songs with a quick tempo produce greater beta wave amplitudes. However, some people find faster paced music more relaxing. When I shared “Ai Chi in 3” music (which varies between a moderate and fast-pace) with a class that had been working with slower music for several weeks, one participant said she found the faster paced music to be relaxing, and added the interesting comment, “but I’m Italian and we like fast music.” The personal preference factor.

Studies show that brain waves are affected by music when it is the type of music that the listener prefers. If the listener likes the music, the music tempo influences brain wave frequency, but if the listener does not care for the type of music, the tempo has less of an effect on brain wave frequency. It appears that personal preference for music turns a switch on or off for the ability of music to cause brainwave entrainment. Heart rate and brainwave entrainment may happen~ or may not, with personal preference being the wild card. As is so often the case, “more study is needed…”

And as Jun Kono reminds us, “However it turns out is how it was meant to be.”