Focus: Ai Chi+ for feet & ankles

Ai Chi performance factors can be varied for different outcomes. When strength or balance is a focus, the base of support set for Ai Chi performance can be wider or narrower, to challenge balance at varying levels and to promote strengthening.

Here’s a personal case study: Almost nine years ago, someone accidentally backed an electric wheelchair over my foot. It was a little sore and swollen, but I ignored it for months before finally seeking help from an orthopedist. X-rays showed that I had a metatarsal fracture, which was declared “healed” following a couple of months of stabilization in a “moon boot.”

While my bone had knitted together, other tissues were affected that caused minor lingering issues. Over the years, my left foot has bothered me off and on with mild swelling, an occasional feeling of “giving out” when going down steps, and intermittent aching and discomfort. I’ve done some self-foot mobilization and had reflexology treatments, both of which were helpful. I found great relief through a friend’s instruction in MELT Method foot mobility exercises and by changing to more comfortable and supportive footwear. I’ve used stability discs for home exercise (see the April 11, 2020 post, Sequestered Ai Chi). The improvements I’ve made for this nagging minor malady have opened the door to a focused awareness of the persisting weakness of my left foot muscles. As I now do Ai Chi, I am mindful of how my feet feel in the “core position” as I go through the first six Ai Chi postures. Moving to Gathering and Freeing, I decrease the width between my foot positions to challenge to the muscles in my feet and ankles. In moving from a semi-tandem (one foot behind and slightly off to the side) to tandem positioning (one foot directly behind the other), my left foot and ankle muscles are getting a good workout. When I move into the one-leg stances of Accepting with Grace, Rounding and Balancing, I can adjust the stance time on the supporting leg to give a good challenge without overdoing it.

Here’s the “plus” I’ve added to my current water exercise for my foot issues: I warm up with several repetitions on both sides of slow heel lifts, holding the raised position for several seconds, then slowly lowering. I progress to doing heel lifts on one side at a time with the opposite knee raised, noticing the difference between my left and right sides. I can increase the challenges while standing on “tip toes” on one foot by moving my raised right leg forward, to the side and backwards, or by holding this position when water turbulence is present. I can also try to rely less on arm movements and more on my ankle muscles to maintain my balance. Finally, I’ve added swimming laps with a kick board and short fins to strengthen my ankles.

Every situation is unique, requiring a customized approach, but you can address particular needs by adjusting components of Ai Chi practice. Watch for more ideas about this in upcoming blogs…

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Always something new…

Ai Chi Day 2021 is nearly upon us, and it promises many valuable presentations to expand knowledge of this practice and to spark ideas for new applications. Since Jun Konno introduced Ai Chi to the world over 2 decades ago aquatic specialists and therapists have successfully shared it with clients with many different issues and in a wide variety of settings. When the 2011 tsunami in Japan left many fearful of water, Jun developed new Ai Chi steps to reestablish comfort in the water. When an aquatic expert in the Netherlands could not find warm water pools where she could share Ai Chi, she developed a faster version that brought many of the same result through a different approach. A pediatric therapist found ways to use Ai Chi to help children with neurological deficits. Other practitioners have brought Ai Chi to wounded warriors suffering from PTSD.

Jun Konno’s gift of Ai Chi has proven to be a very useful tool that can be adapted to many situations, if we look mindfully at the possibilities and do not get caught up in performing it in one particular way. Jun often shared the Japanese proverbial saying: “Willow will not break under weight of snow.” The strong branches of trees can support the weight of snow in winter, but if too much snow accumulates, the branches will break. However, the willow tree does not need to bear as much weight. Its flexible branches are able to bend so that snow falls off, yet they are strong enough to spring back in shape.

Those who have been vaccinated against COVID-19 also seem to be protected against the new variants of coronavirus, (at least for now). However the variants are more aggressive and spread more easily than the original virus, making those who are unvaccinated at a higher risk of contracting it. Even a mild case can lead to long lasting, often debilitating symptoms~ now recorded at a rate of one out of every three who have tested positive for COVID. Ai Chi holds the possibility of addressing many of the most common COVID symptoms, however mindful adaptations are needed to avoid relapses. Both the CDC and the APTA have developed guidelines for assessment and outcome measures for post-COVID syndrome for healthcare professionals, including evidence based tools for fatigue, breathlessness, exercise capacity, balance, pain, functional mobility, cognition and anxiety. The results of these measures will shape the Ai Chi practice for each individual. And a prudent model will be needed for safe and effective general community group applications for extended help once therapy services are exhausted. Once again, however it turns out is how it was meant to be.

Please register at the following link to join ATRI for a very special online Ai Chi Day on Sunday, July 25, in celebration of Jun Konno and Ai Chi:
https://ruth-sova-103927.square.site/product/ai-chi-day-2021/452?cs=true&cst=custom

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Ai Chi walking

Ai Chi is an amazing practice in its pure form. But Jun Konno’s mantra that “however it turns out is how it is meant to be” opens the door to infinite possibilities for variations. It may feel right to prolong doing a particular step. You may develop your own “holding pattern” step to settle and reorganize in the midst of doing Ai Chi. One Ai Chi master has developed flowing ballet steps in her Ai Chi practice, while another has doubled the tempo to adapt to colder water temperatures. There are partnered versions of Ai Chi for those who are fearful of the water, with advanced mobility issues and for children.

“Warm water walking” is commonly recommended for post-injury and post-rehab patients who are not able to participate in other exercise classes. I like to include a walking variation of Ai Chi at the conclusion of my GaitWay to Mobility water walking classes. In the class we typically begin with a mindful walking experience, then ramp up to walking activities at higher exertion levels. Ai Chi walking provides a great way to cool down from higher level exertion, as it prevents blood pooling in the legs and lessens the likelihood of post-exercise blood pressure drops, lightheadedness, fainting and cardiac arrhythmias. Plus doing Ai Chi at the end of class leaves participants feeling relaxed and refreshed!

I often refer to the first 5 steps as the “core Ai Chi steps”, because they are performed in a planted posture that challenges the core muscles of the spine and trunk. They set the foundation for mindful movement and focused attention, and I like to do them in their traditional form. But variations on the middle steps are a great way to incorporate locomotion in Ai Chi practice. The Ai Chi steps can be a bit challenging until participants have practiced enough to be able to move without cues, so look to the movement needs and degree of attention engagement of your participants as you make decisions about introducing more complex variations.

An easy foray into Ai Chi walking is with the moving steps. Flowing is already a walking variation~ it is basically “braiding” or a “grapevine step.” Reflecting and Suspending transition to Ai Chi walking by moving in a prescribed direction~ alternating between left arm and leg over right and turning 180 degrees, with right arm and leg over left and turning 180 degrees. These movements can be done straight across the pool or in a circle.

The balancing steps are also prime walking steps, but require more cuing. I’ve included diagrams below outlining these movements.

In Accepting, shift back, arms back, front toes lift as usual, but as you shift forward onto the front foot and arms come forward, take a step forward with the back leg bringing weight forward, and repeat the cycle.

Accepting with grace follows the same pattern with a front leg lift in place of front toe lift and stepping forward with the back leg as the front leg comes down, weight shifts forward and arms come forward.

In Rounding the back leg comes forward toward extending arms, then lowers straight down to a forward position as the arms move back, rather than returning to its original position. The opposite leg is now to the back, and becomes the next leg to move forward toward extending arms.

Doing Balancing as a walking exercise is a great intermediate step for those who struggle with an extended single leg stance time in traditional Ai Chi. Lean into the forward leg with arms extending forward and back leg lifting behind. Then swing the back leg forward, arms and trunk extending back before setting the moving leg down in front of you. This leg now becomes the forward, stance leg as you repeat the cycle.

Not challenging enough? Do these movements going forward across the pool for several steps, then try them in reverse, moving backwards across the pool. Not only are you challenging different muscle groups, but your mind is working in new ways as well.

Music tempo sets the pace for water walking, and this is another adaptable variable to consider in your planning. I like to use a few tracks from Katrien Lemahieu’s Ai Chi in 3 music for a 10 minute Ai Chi walking cooldown.

Are you interested in learning more about GaitWay to Mobility? I will be teaching a pool workshop at the ATRI 2019 Fall National Aquatic Therapy conference in Chicago, November 7-10. For more information, visit the ATRI website.

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Your choice…

It was the last class in an Ai Chi series, and we opened with Ai Chi in 3, a lively version of Ai Chi that was new to the class members. We transitioned to traditional progressions with Jun Kono’s Ai Chi Synchrony. Finally, we moved through the water to my favorite Ai Chi music, Carlos Nakai’s Canyon Trilogy. This music always reminds me of a wonderful family trip to Chaco Canyon in New Mexico many years ago. We set off in different directions to explore the ancient Pueblo ruins, each of us on our own journey into the past. Unexpectedly, soft flute music drew us to one of the dwellings, where we found our teenage son playing a newly purchased Indian flute. It was a precious moment that forever linked the good feelings of a special family time to the sounds of the Native American flute.

As our Ai Chi class concluded, one of the group members asked, “Can certain music make you feel sad?” I replied that studies of remote cultures around the world have shown that slow music with predominantly minor chord progressions have a universal effect of creating a feeling of sadness. I added that personal experience with music can also create emotional associations. She then shared that she felt sadness during Ai Chi Synchrony. This surprised me, as Ai Chi Synchrony is not in a minor key and her experience with it was limited to our class. Suddenly it hit me~ it was not the music that was affecting her emotions… It was me.

I love sharing Ai Chi with others. Ai Chi has many positive effects~ improving balance, enhancing breathing, extending mobility, core strengthening, pain relief, stress reduction… But the aspect that I most appreciate in this world that seems skewed toward a first response of anger and hate, is the ability to find centering and calm. One of my class members has commented that she feels tensed up a lot of the time, but when she does Ai Chi she is relaxed for the rest of the day. On this particular day I was feeling sad that a very fun series was coming to an end. I was also in the midst of processing some upsetting news I had recently received. At the start of the class, the group was fully absorbed in new learning with Ai Chi in 3. Ai Chi Synchrony brought familiar territory, and the group was more fully able to soak in the moment~ and to subconsciously absorb my shallowly buried unsettled feelings. Fortunately, the last music selection rescued my frame of mind and lifted the spirits of the class.

I have often asked my class participants about their favorite music genres to create customized playlists based on recognized attributes of relaxing music. Personal preference is the bottom line determinant as to whether or not music is relaxing, so what is very relaxing for one person may be less so for another. But in a class, there is another factor in the mix~ the chameleon effect of participants as they consciously and subconsciously mimic the leader. Ai Chi class preparation includes setting your internal tone as well as the external surroundings. Yes, your role is to be a facilitator but you cannot escape being a part of the experience as well.

What is the most relaxing class music? The leader’s favorite.

Upcoming Ai Chi classes in Evanston, IL: Join me doing Ai Chi at the Evanston Athletic Club on Tuesday and Thursday mornings during the month of September, 2018. Call (847) 866-6190 to reserve a spot.

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Water reflections

This week marks the conclusion of my latest “pop-up” Ai Chi class. I love sharing Ai Chi with others. The physical benefits of core strengthening, extending mobility, improving balance, enhancing breathing and relieving pain along with the gift of internal calm and stress reduction are all things I want to pass on to others. But I always come away from each encounter having learned much myself as well. This series of classes was no exception.

The size of the shallow area of the warm water pool where I taught this class limited my class size, so it was easy to observe the participants and gauge the speed of progression to their needs. This particular group enjoyed new challenges, so while the movement patterns were consistent with each practice, I introduced a new concept or different type of music every time we went through the steps. And to make the experience personal, I asked participants about their class goals so that I could emphasize those aspects during practice. Because relaxing music has so much to do with personal preference, I asked them what type of music they liked and compiled a new Ai Chi Kitaro playlist based on their feedback.

I generally demonstrate from the pool deck while class members mirror my movements in the water as I give verbal directions. Landmarks have been helpful for large movements (“turn toward the wall,” “face the lap pool”) but figuring out which arm or leg to move was distracting for this group until I began specifying “right limb” or “left limb” which was opposite of what I was doing. When I noticed that space issues were restricting movement during “flowing,” we embraced the Ai Chi focus on roundness and transitioned the group to circling clockwise, then counterclockwise.

Ai Chi is considered a body mind practice~ with a primary focus on body stabilization and movement. Mindfulness is often considered to be something that “just happens” when muscle memory kicks in or when we achieve flow. I decided that I needed to know more about mindfulness, and enrolled in and completed an interesting and challenging online certificate program through the University of Leiden in the Netherlands called “Demystifying Mindfulness.” This led me to add a focused meditation to our practices, either between Ai Chi cycles or during an extended final “contemplating” step. While the goals of our group were primarily body focused, they appreciated this addition, gravitating mostly toward the breath-focused meditations that tie in so well with Ai Chi breathing. And I found that by focusing within, my eyes were opened to experience more around me.

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.