I recently had a class participant who had peripheral neuropathy due to lumbar spinal stenosis. Arthritic changes in her low back vertebrae were pinching the nerves traveling down into her legs, causing back and leg pain and loss of sensation on the bottoms of his feet. She had lost the ability to sense the bottom of the pool.
Balance is dependent upon input from vision, the semicircular canals in the inner ear, and from somatosensory receptors in our joints and muscles. My challenge was to find a way for this class member to do Ai Chi despite her somatosensory deficits. Thankfully, vision and her inner ear mechanisms allowed her to walk and function on land. But even standing still in the Ai Chi “core posture” was difficult, and that was where she needed to start. She held her own pretty well with contemplating, floating and uplifting, but after that point her trunk and leg muscles were working so hard to remain upright, that she felt back and leg pain creeping in. Fortunately, our pool had a sitting ledge, allowing her to sit as she performed the next few steps, but then it was time to stop moving and simply focus on breathing as the rest of the class moved through the remaining steps. Ai Chi cannot be done “wrong way,” however it turns out is how it was meant to be, and this was her way of doing Ai Chi that day.
Recent EMG studies comparing muscle activation during land versus water walking show that most leg muscles don’t work as hard in water as they do when walking on land. This could be due to arm movements during water walking, or to a lower stride frequency and shorter stride length that occurs as a result of buoyancy and drag influence. Buoyancy also produces reduces ground reaction force, which may have had an influence on muscle activation. Another causal hypothesis is that buoyancy and hydrostatic pressure may influence reflexes that are activated by pressure receptors in the body.
The gastrocnemius muscle is an exception to this~ it fires at similar levels on land and water and shows a continuous tonic activation in the water, likely in response to drag forces. And soleus activity is higher with weight loading in the water. This is important because weight loading stimulates activation of the joint and muscle receptors.
So what can be done to help somatosensory problems? Of course the degree of nerve damage causing the deficits will be the limiting factor, but joint loading and movement stimulate joint neuroreceptors and paced Ai Chi provides a supportive and safe environment for weight bearing and movement.
An Ai Chi guide must be aware of the physical issues impacting class members and invite changes when participants struggle or cannot maintain form. A “good” Ai Chi practice does not necessarily mean getting through all of the steps~ it is about the perfect experience of Ai Chi in the moment, as it was meant to be.
Join me in November for GaitWay to Mobility at the ATRI Fall National Aquatic Therapy Conference in Chicago. Go www.atri.org to sign up!
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