Class ideas. Empty and Full, a sense of interoception

Like many other teachers of Mat Pilates classes I like to have a theme for my classes each week. The inspiration for the themes could be from something I have read, an interesting lecture or workshop. Often it is just one element, a phrase or movement, which appeals to me and I expand it to be a theme not only for the mat class but into the studio as well, the challenge is to apply the theme to all the different bodies I see during the week adding variety and interest to the sessions. This theme develops as the week progresses and my creative side gets going. I'm always thinking that I should write it down these ideas for re-cycling at another time or as inspiration for other teachers.

Last week I was at my Tai Chi Class on Monday morning, it's such a lovely way to start the week, especially if I have been away training all weekend. We were going through the 'form'( a set series of moves), taking instruction from our teacher, Mike, who is so patient with those of us who struggle to remember the precise movements from one week to the next! Sometimes Mike reads from a translation of the original teachers instructions and the way of describing the feel of the movements is often very beautiful and insightful. On Monday the instruction to make our legs feel empty or full depending on whether we had our weight in them or not struck a cord and I played with this idea all week.

Before I give you some ideas on how I took this theme into a class, I just wanted to look at the idea that the teacher was describing how the move felt to the mover. I think that this ancient teacher was describing the feeling or emotion the moves might evoke. I wondered if this could be encouraging interoception. This may be a new word to many of you. We have all heard of proprioception, which is a sense of where your body is in space. Placing a hand on someone's back as they are moving gives them proprioceptive feedback as to how they are moving. The machines are constantly providing proprioceptive feedback, using small equipment in a mat class also trains this sense.
Interoception is defined as a sense of the physiological condition of the body, including, for example muscular effort. They are almost always attached to an emotion. The sensations are triggered by stimulation of free nerve endings, most of which are found in fascial tissues throughout the human body. Proprioception and interoception however are organised differently in the human brain. Anxiety, depression or irritable bowel syndrome have been described as interoceptive disorders. Robert Schleip and Heike Jager provide a very full description of interoception in the book Fascia (Elsevier 2012), providing full references for their research.

Put simply Interoception is how your body feels or is perceived by you.

In last week's class I asked my participants to firstly understand the idea of empty and full, considering their body, their arms, legs and head as a containers which is either full or empty. To each of us the words full and empty has a different meaning, I used all kinds of imagery to evoke this feeling. Something which is empty is light and airy, cool, something which is full is heavy and warm. Changing an angle changes the way their containers ( their arms and legs etc) feel, smooth changes of leg,arm positions required a smooth transfer of weight and content. Different body positions created new challenges, rolling like a ball meant a feeling of momentum caused by the contents of the container moving from one end of the body to the other. Sitting or standing made the head light ( describing it as empty brought a burst of giggling!) the feet/pelvis heavy or full. To keep the pelvis level, when in neutral for instance, I used the image of a bowl half full of liquid. Bringing this self awareness of how the inside of the body feels, makes it interoceptive in nature.
I also encouraged my class members to enjoy the feeling of their body moving, no discomfort or pain should be experienced, again this is subjective, listening to the body, how it feels today is very important, particularly in a class when the instructor has so many body's to watch, if a class member can feel and enjoy the movement, it becomes a safe movement.

I believe that as instructors we can encourage awareness and build the senses of interoception and proprioception of our class participants. A manual therapist can use touch to stimulate the fascia to encourage proprioception and interoception, as movement teachers we can use movement, the power of imagery and gently well placed manual cueing to do the same.

This was a fun theme to play with, it worked well keeping the movement smooth and rhythmic - no sudden, jerky moves. The class members enjoyed the challenge of the theme. The only down side is that as an instructor it involves a lot of talking, so take a drink into class and remember to warm up your voice beforehand and rest it after.

Tracey x
(c) November 2012

Tensegrity

This wonderful Summer of sport is about to come to the end. Many of us in the UK will have had the experience of attending the Olympic games and Paralympic games in London. I was lucky enough to go to the Olympic Park last night and watched Oscar Pistorious win the 400 m imperiously. 

The Paralympicans have amazed us with their athleticism. I heard many spectators say ‘how do they do that?’ How can a one legged man do the high jump or a one legged woman turn cartwheels after her long jump; check out the youtube video’s; I have attached one here for you to watch and be inspired to bigger and greater achievements.

 <iframe width="420" height="315" src="http://www.youtube.com/embed/34uRrkZsxI4" frameborder="0" allowfullscreen></iframe>

The newspapers have had some spectacular pictures of athletes captured in mid air, making shapes in the air, holding form against the effects of gravity.

How do they do that? how can the body hold shapes in the air, defying gravity?

I think its all to do with tensegrity. The fascial ( connective tissue) network acts as a tensegrity structure, allowing supported movements of our arms, legs and body. A tensegrity structure is made up of compressed struts (bones) and elastic strings (connective tissue or fascia and muscles). The resulting structure holds space in the body, from both a cellular level to a full body level. We all use our internal tensegrity structures all the time. The paralympians  use their fascial network to defy gravity everyday. 

I have been making tensegrity models, yesterday I built one which mimics a spine, it’s great fun to do, but also by making the models you can appreciate how they divide space, make space and surround space. Look them up on www.biotensegrity.com, 

Hope you have as much fun making the models as I did.

congratulations to everyone who got to the Olympics, competitors, officials, game makers and the great spectators. 

Tracey Mellor

(c) September 2012

Workshops in Fascia Fitness

Today is my first day back to work after my summer break. I've returned refreshed and ready to get on with the next phase of my Fascia Journey. 2 years ago I promised myself that I would devote the next 2 years to investigating fascia research. At first this was a personal interest which I used to inform and inspire my work in the Pilates studio, beyond this I had no great ambition. I enjoyed passing on interesting fascia facts to my clients. I've attended workshops, congress, courses, meetings; read books and research articles. I have met and spoken with many of the men and women leading the fascia revolution, I have been inspired and, in some cases, shocked by the lengths they have gone to further their research.
I have known for a while that fascia can be changed and trained by movement; also if neglected fascia can deteriorate and be easily damaged. Neglected and damaged fascia effects our ability to move without pain. I know that Robert Schleip and Divo Muller have been teaching courses on how to keep our fascia fit, and I have attend several of them in London and Germany. The principals are simple to grasp once a basic understanding of fascia is obtained. The principals can be layered on top of existing exercise or movement systems. For the last 2 years I have been applying these principals to Pilates. This has involved a certain amount of creativity which has been fun for everyone involved. The idea for this blog was born out of the want to record and share the experiences of applying these principals to the Pilates system.
Earlier this year I wanted to make sure that my way of applying the principals to the Pilates system was in line with the Fascia Fitness Association's standards and made a series of videos. A compilation of short clips I set to 'bounce' music for a bit of fun and gifted it to Robert and Divo when I met them in Canada at the Fascia Research Congress. I have attached this private video to this blog for information/education and not for public publication or reproduction. Following the video's and because of the level of my interest in Fascia research and it's application to movement I was awarded a qualification to teach teachers about Fascial Fitness.
In truth I have been daunted by the amount of information which needs to be imparted, where to start?
Preparation of workshop material has now begun.
Workshops will be presented on 3 levels:-

Introduction-   Understanding Fascia and Fascial research .

Application-    Understanding Tensegrity, Myofascial Meridians, lines of tension and elasticity in the body,sensory ability of Fascia and the importance of hydration on Fascia.

Fascial Fitness- Application of Fascial Fitness principals to movement/exercise for the enthusiast,instructor and educator of instructors.

Enjoy the video- it was made for fun.

Tracey Mellor
(c) August 2012

Approved Fascial Fitness Trainer

Tracey Mellor is the 1st Pilates Fascial Fitness Trainer approved by FFA

Yesterday I was told that I had been "approved as certified Fascial Fitness Trainer" awarded by the Fascial Fitness Association which includes Robert Schleip and Tom Myers. There are only 4 FFT's so far and I am the first Pilates based trainer in the World!.

What does the certification mean?
When I told my news to this morning's class they were worried that I would be changing the way I teach and/or putting my prices up -worry not, neither will be happening.
In reality I have been teaching within the Fascial Fitness principals for quite a long time. I have studied Fascia and been on many Fascia related courses over the last 8 years. The Fascial Fitness principals fit in quite neatly with teaching Pilates on the machines, I have already introduced the Fascial Fitness language into the classes, and smile when my clients start talking 'Fascia Fitness' amongst themselves. More importantly I can see, and my clients can testify that their bodies are changing very slowly ( it is a slow process) because of the change in emphasis. One client said this morning that even if her mind couldn't remember the exercises her body did- I couldn't have put it better myself.

What happens next?
We are being encouraged to conduct FF workshops. This is an exciting prospect and it will need some careful thought. There are some Fascia workshops already planned by at least one of the FFT's.
The reason for the hesitation?
The world of Fascia is continuously changing as more research is undertaken. This means that FF principals will need continuous maintenance. To teach the Fascia Fitness principals involves teaching their incorporation into existing exercise systems. This means that a complete new way of approaching fitness has to be encouraged and adopted. It isn't just another set of exercises to be taught, it's a different way of thinking. There will be resistance, as there is with anything new, and the current ideas will need to be revised to take account of new findings and reactions, but in the end I hope that adoption of the FF principals can transform the way we approach the health and well-being of our bodies and minds.

Congratulations to Jo Avison, Carrie Gaynor and Sol Petersen the other new FFT's


Tracey Mellor
(c) May 2012

Orange Fascia video

Orange Fascia Video- Vancouver 2012

This is a video that Jo Avison and I made in Vancouver. We realised that the words used to describe the ways muscles and bones move were not always appropriate for fascia so this video explored a new language.

The orange is often used to explain fascia and how it holds and divides space within the body.

Jo has done a great job in this video, I have attached the whole video clip unedited. It was our second attempt as I had my finger over the microphone on the phone for the first one!- so we had to buy some more oranges and start again, I have one silent movie and one with sound, we may play about with the clips and add voice overs but for now enjoy this one. It is very much of the moment, post congress and inspired by a need to find a language to describe how fascia works in the body.

Tracey ( the camera or more accurately the phone woman)

Chronic Pain

Chronic Pain

We all have experience of clients coming into class or the studio who have chronic pain. Many attempt to carry on with their lives, continuing classes because they believe that movement is helping. It's up to the teacher to respect this brave decision and not make matters worse. We adapt exercises, listening and observing carefully. In some cases we have to gently persuade the client that today may not be a good day to exercise.
I thought it would be helpful to record some of the comments made by the presenters of the post-congress workshop on Chronic pain, Fascia and Feldenkrais. The workshop was taken by fabulous presenters, Diana Thompson and Barbara Frye, who are lecturers in Massage therapy and Feldenkrais practitioners.

Chronic pain statistics

• Globally, 1 in 5 people suffer from moderate to severe pain (IASP)
• 1 n 4 people aged over 65 live with pain (IOM)
• 116 million live with chronic pain in the U.S. up 40 million from 10 years ago! (IOM)
• unrelieved pain is more prevalent in low and middle income countries with an increasing burden of chronic disease - AIDS, Cancer (WHO)
• Global war on drugs is leaving countries without access to pain medication - Uganda, India, Ukraine. (the pain project)

The IOM report on relieving pain in America - we were encouraged to download, sets out suggested underlying principles:

• Effective pain management is a moral imperative, professional responsibility, and duty of people in the healing professions
• the importance of prevention
• clinician, patient and family working together
• Public health and community based approach

I liked the idea of the patient working along with the clinician or in our case instructor, as movement requires the client to move themselves. This is quite a big jump from being moved, and requires more effort and engagement on the part of the client. We should not forget that for someone with chronic pain just getting to the class sometimes requires huge effort. 

Conditions associated with Chronic pain:

• Aids, Cancer
• Arthritis, back pain,neck pain,headache
• Diabetes, herpes, Lyme
• Fibromyalgia,syndromes (chronic fatigue,irritable bowel, myofascial pain, phantom leg)
• Spinal stenosis,sciatica, restless leg syndrome
• inflammatory nerve conditions, neuralgia/neuritis (brachial plexus, thoracic outlet, carpel tunnel)

Types of pain:

• Nociceptive - dull, achy, poorly localised, sensory receptors or neurons perceive pain and sends pain signal to the brain
• Neuropathic - burning, tingling, stabbing, pins and needles. central nervous system disorder
• Allodynia - pain due to a stimulus which does not normally provoke pain, involves a change in the quality of a sensation.

Pain definitions/ therories:

• Acute pain serves a vital function as a warning sign of injury or infection, typically responsive to treatment
• Continued pain, once it's warning role is over, is maladaptive, unresponsive to typical treatments
• Chronic pain results in changes in the peripheral and central nervous system that aid in it's persistence.

Chronic Pain definition

• often a disease in and of itself
• A complex pathology - cognitive, behavioural impairment, anxiety, depression, sleep disturbances, function
• A dysfunction of the nervous system - neuroplastic changes, pain signals active even when resting
• original injury is no longer the source of the pain.

Complications of pain

• Psychological factors  - pain and fear of pain affects how people move, limited activity leads to de-conditioning and a drop in well-being
• Neuroplastic changes - toxic effect of prolonged excitation, cortical damage - sensory and motor changes
• Fibrotic connective tissue - compromised muscle function which leads to an increase in fibrosis and this in turn can lead to a decrease in lymph and nerve flow
• Predisposed to future exacerbations
• vulnerable to unusual activity, from new sports to prolonged sitting
• if nerve inflammation is present, cannot tolerate normal activity or full range of motion, according to pain research and practice, 2010 American pain foundation, nerve inflammation can cause damage to nervous system, damage to circulatory system, damage to soft tissues and organs, suppression of immune system,  excessive inflammation and delays healing

From the above information we can see that chronic pain will affect the way a client moves and approaches movement. The bodies fascia changes in response to chronic pain.

The workshop went on to list treatment guidelines for massage therapists. As movement teachers/instructors it is not up to us to diagnose, just to be aware of the issues surrounding chromic pain. The treatments however can be adapted to the movement world.

Treatment guidelines

• Do not cause pain
• Address the whole body
• Give the body time to rest during a session
• Use awareness as a tool for learning/neuroplasticity
• teach self-care for in between sessions

Research on massage/bodywork for chronic pain

• Maintaining mobility is an important component in decreasing pain in older adults; stretching, strengthening, balancing and self massage can help. ( Tse et al, journal of clinical nursing 3/11)
• Long term benefits of myofascial release/massage on sleep, short term improvements in pain, anxiety and quality of life. ( castro-Sanchez et al Evidence-based CAM, 12/11) - I wonder if they looked at restorative movement???
• multiple-disciplinary treatment more effective than single treatment approach; exercise, massage, lumber supports, education, hot/cold packs, traction, low-level light therapy etc ( Van Middlekoop et al, European Spine Journal, 1/11)
• 6 Alexander lessons nearly as effective as 24 when combined with exercise homework one year post treatment ( Little et al, British Journal of sports medicine, 12/08)
• Fascia innervation is nociceptive and likely to be responsible for nerve trunk pain ( Bove 2009)
• Movement at ankle and hip results in nerve motion at distant joints ( Hodges 2006)
• Nerve endings are concentrated where stresses are the highest (Solomonow 2004)

I think that the research is quite exciting for movement teaching. Pilates and Yoga addresses the whole body. One of the things I hope I teach my clients, is a greater awareness of their body, re-learning movement patterns etc. we use rollers and rolling to create localised myofascial massage for the tissues. We move and use our fascial net to move, keeping the fascial fabric healthy is, I believe, very important for my chronic pain clients.

Tip of the iceberg- international fascia research congress 2012 overview

Tip of the iceberg

I have just returned from the 3rd International Fascia Congress where  800 delegates and at least 100 presenters and exhibitors, met and shared their research, experience, observations and aspirations over 5 days of  conference , pre-conference and post conference workshops.

The theme of the conference was:-

What do we know? What do we notice? continuing the Scientist-Clinician Dialogue .

So why was I there? I am neither a Scientist nor a Clinician in the accepted definition of the word. I am a Pilates teacher who has spent the last 8 years soaking up every aspect of fascia research she can find. I started with the myofascial chains or lines, released by Rolfers or Structural Integrators, moved on to workshops  with Fascial research leaders such as Tom Myers and Robert Schleip, undertook applied myofascial anatomy qualifications, listened to webinars and read many scientific papers. I then integrated it all into my Pilates teaching. 

In my Studio and in my classes I notice a lot and I think that movement teachers/therapists have quite a lot to add to this conversation.

I was not totally alone as a movement teacher at the conference, I travelled with a Structural Integrator who is also a Yoga teacher, the partner of one of the main contributors is a movement teacher and several physiotherapists/clinicians attending had a Pilates/yoga/movement qualifications. We were, however, very much in the minority.

It is hard not to feel intimidated by science. Many of the scientists were there to protect their reputations, showcase their expertise or to challenge common held beliefs.  The atmosphere in the conference hall was often drenched in the emotions of awe, amazement, confusion, respect, admiration and fear. It was a privilege, and a challenge, to be part of it.

It will take a while to assimilate everything I heard, The Congress book measures over 1 inch thick, my hand written notes run to over 50 pages of highlights to be looked up later. Luckily the congress was video taped and re-hearing many of the keynote addresses is something I am looking forward to, as I know that  of the hundreds of pieces of information flung out to the delegates, only a very small percentage was successfully caught and scribbled down.

Along side the main congress hall and keynote addresses, there were Posters to look at. Each of these posters represented research projects undertaken all over the world. The exhibitors included  Clinicians, Scientists and Students and each one had the opportunity to present their work to the delegates during the congress. Amongst these posters there several research projects which included movement therapies. The posters however demonstrated the problems in trying to prove that an intervention, be it clinical, manual therapy or movement/exercise based,is very difficult to do in an objective manner, which can be presented to and scrutinised by the scientific world.

The congress timetable was very busy. We started at 8 am and listened until 5pm with coffee and lunch breaks. We had one evening session where we watched the multimedia presentations until 9 pm. In the breaks we mingled with the other delegates, normally starting with where we originated from ( our passes gave our names and home countries only), it then progressed onto what we did. From my point of view often the conversation stopped there, as many of the congress delegates were there to make useful contacts ( Pilates teachers aren’t considered useful!!), however I did meet some wonderful people and once we started to chat about the research we had much in common and I think I may have persuaded some that movement teaching does belong in the conversation.

I had the huge advantage of traveling with someone who had been to the first 2 congresses and who had worked along side many of the clinicians who were presenting at the congress. At our breakfast table we discussed new ways of ‘scientifically’ measuring changes in fascia following interventions, over supper we talked about how exercise and manual therapies could be measured to benefit clients.  

I attended a post- conference workshop delivered by Massage therapists on Chronic pain. The lady sitting next to me was a little put out that she would be working with a non-clinician, but I had the last laugh when the presentation moved onto proprioception and movement. I was on home turf. When we were taught ‘pelvic clock’ I couldn’t help chuckling to myself. I was, by that point, totally convinced that movement teaching does have an important contribution to the world of Fascia research. 

For me the most wonderful thing about the congress was that there was no question that Fascia is an important part of the human anatomy, not just the throw away wrapping around the muscles and bones. The body wide web was universally accepted and expanded upon. We could concentrate on the beauty of the bodies movement from within. Although there were still arguments about what each layer of Fascia should be called, there was no argument about the part it plays in proprioception, or pain. loose connective tissue was described as the ‘forgotten organ’ .We discussed ‘the secret life of water’ and fascia as a highway for the immune system. I know that we were all ‘fascia-holics in the room, only there because we believed, but as one speaker said: just because we believe in it’s existence does not make it a religion, this was Science and we could prove it.

Where does movement fit in? - Well I believe that the Fascial network is the bodies movement system. If we waited until our brain told our muscles when to move life would be very slow and jurky- like a robot’s movements. Fascia glides and reshapes, holds structure, encloses and connects,it moves internally so we can move externally with ease and grace. When the system is challenged or breaks down through injury, disease or under or poor use we lose this grace, we experience pain. The medical profession can fix our bodies, the massage therapists and manual body workers can move our tissue but ultimately it is up to each individual to move themselves, to make sure we keep our bodies and our movement system , our Fascia, healthy and that is where the movement teachers have their part to play and that is why I went to the congress and that is why I want to bring the research on Fascia into the movement world.

This is the tip of the iceberg, there is so much more for us to discover.

Tracey Mellor

April 2012 (c)

Proprioception-the 6th Sense

What is proprioception?

Divo Muller at a recent Fascial Fitness workshop in London defined it as our 6th sense; the"body and movement"sense. Without a proprioceptive sense we could not feel our bodies.

To have this 6th sense we need to have sensory feedback, we only need to remember the tragedy of the Romanian orphans, who were left without sensory feedback in the form of touch, to know how damaged a person can become when deprived of this proprioceptive sense of body.

The proprioceptive sense is perceived using our nervous system. There are some medical conditions where the nerve endings become damaged and a lost of proprioception occurs. Ian Waterman had such a medical condition, many in his situation cannot walk, he taught himself to walk using his mind and his other senses such as sight, however when the lights go out he falls to the floor as he has no idea where his body is. You can see part of the BBC documentary about Ian Waterman on Youtube.

The fascial (connective tissue) system is far more innervated than muscle, it can be argued that proprioception and kinaesthesia are primarily fascial not muscular.
There are 10 X as many sensory receptors in our fascial tissues than in the muscles ( Stillwell 1957).
The receptors include: Golgi tendon organs which measure load ( by measuring stretch in the fibres). Paciniform endings, which measure pressure. Ruffini endings which inform the central nervous system of shear forces in the soft tissues. Interstitial nerve endings which do everting the others do plus, apparently, pain (Stecco et al 2009, Taguchi et al 2009). This means that when, you think, you feel your muscles move you are more likely to be connecting into your fascial network.

From a Pilates, Yoga or movement teachers point of view, particularly those in rehab or re-medial practices, proprioception has another interesting property. It has been suggested that pain and proprioception cannot exist at the same time, like oil and water they do not mix. This follows research done by Helene Langevin amongst others.

For all the above reasons we should encourage our clients to keep their fascia fit and to hone their proprioceptive sense.

How can we do this?-

Pilates, yoga, tai chi and other holistic exercise practices already improve body awareness.
Lying in semi-supine, in pilates neutral for instance, gives the client feedback or a proprioceptive sense of how their back is positioned. They will know how much pressure is being placed at different places along the spine or across the shoulders for example. They will be able to feel changes when limbs are moved or lifted. At first many of my clients would look blank when asked how their back felt, their awareness of movement and their proprioceptive sense was not yet honed. Many associated pain with movement, they insisted they could not feel anything unless it hurt. Bringing awareness and the proprioceptive sense into the exercises makes a big difference.
The Pilates machines provide even more opportunity for proprioceptive feedback.
Footwork on the reformer provides proprioceptive feedback for the back as it lies on the carriage, the shoulders if they touch the shoulder pads, the feet as they rest and push against the foot bar . Swan on the barrel provided proprioceptive feedback at the heel/foot, at the hips and pubic bone and the front of the body as it takes on the shape of the barrel.

In my studio improving body awareness, the "6th" sense is a big part of the Pilates training.

Tracey Mellor
March 2012

First Post- The Poetry of Fascia

The Poetry of Fascia

In my Studio I have a blackboard upon which I write things which I think my Clients will find interesting or helpful.
My most recent scribbling is part of a poem written by Gil Hedley about Fascia.
I was introduced to Gil by Robert Schleip last year at a Fascia Fitness lecture in London. Gil runs courses on Human dissection and is perhaps most famous for his 'Fuzz speech' which you can view on Youtube. He made quite an impression on the audience, his enthusiasm for the subject was obvious for all to see. However the thing which stays with me was his reading of a poem which he had written about Fascia.
I copied down the last few lines of this poem onto my blackboard as they represent the reason why I love to teach Pilates and why the Fascia research being undertaken around the world is so relevant to my teaching.

"A moment bound in doubt of freedom can seem like an eternity"

This line sums up something many of us fear, the inability to move without pain. Even a few hours of muscle stiffness is tiresome, a broken bone is painful, a torn ligament is a long time mending. 

Movement is essential to well-being. Gil's Fuzz speech humorously explains how the loose connective tissue, he calls fuzz, can bind the body together if there is no movement. Pilates and other whole body movement exercise such as yoga and Tai chi ensures that the whole body is moved. New research is allowing us to understand how we need to move to keep out fascia healthy and not allow the "fuzz" to bind our body together.

One of my clients has added this line of his own to the blackboard.

'One moment of not letting people know what you are thinking may leave them in doubt for an eternity"

This too is true - thanks Mike for reminding me that we should share our understanding.

Tracey Mellor Feb 2012