What's your story?

That constant dialogue in our head… that’s not just background noise of your day-to-day thoughts. It’s also the basis for the story we tell ourselves, about ourselves.

And while some the chatter can be louder at times, all of the stories we tell ourselves matter.

It’s how we form our identities and make meaning in our lives.

To understand the identity formation process is to understand how individuals craft narratives from experiences, tell these stories internally and to others, and ultimately apply these stories to knowledge of self, other and the world in general. In an era of evolutionary psychology and neuroscience, [research continues to show] how individuals look for meaning and spiritual depth in life [through narrative;]. (Journal of Personality 72:3, June 2004)

And these stories are not just limited to what goes on “upstairs” in our minds. Those stories can also literally change our bodies and how we feel.

And don’t just take my word for it.

From the experts:

This study is the first to demonstrate that self-talk significantly reduces rate of perceived exertion and enhances endurance performance. Medicine and Science in Sports and Exercise 2014, 46 (5): 998-1007

To those who choose to experience it for themselves:

“Fear, to a great extent, is born of a story we tell ourselves, and so I chose to tell myself a different story from the one women are told.  I decided I was safe.  I was strong.  I was brave” – Cheryl Strayed, Wild.

 

Here’s the challenge

When I read this, I’m tempted to just start telling myself a narrative that’s nice to hear but denies how I really feel. (I’m strong – when I feel weak.  I'm calm, everything is cool - when I’m really pissed off.)

Well – we can’t fool our bodies.  If we sense danger, anger or excitement, our bodies react unconsciously and automatically.

In fact, as the [neuroscience] research has drawn a stronger connection between our bodies and emotion, the consensus is developing that our bodies reflect our emotional state - whether that's sadness or joy, anger or calm - our muscles, viscera and connective tissue hold and reflect our emotional state. (Damasio, Antonio. The Feeling of What Happens: Body and Emotions in the Making of Consciousness, 1999. pgs. 286-287.) 

If there’s a disconnect between what we’re telling ourselves and what we actually feel – our bodies will call our bluff.  That's why it's called body language.

St. Thomas does a pretty good job explaining this.

“If you bring forth what is within you, what you bring forth will save you.  If you do not bring forth what is within you, what you do not bring forth will destroy you” (Saying Number 70 from the Gospel of St. Thomas (The Gnostic Gospels))

but Seinfeld might do it better

 

 

Here’s what we can do about it

There’s nothing wrong with starting to change the narrative to what we want (saying I want to feel strong even when I feel weak), provided that we are honest with ourselves about how we really feel.  Provided that we acknowledge where we actually are, and then are willing to engage honestly about how we can become what we want.

Cheryl Strayed changed her narrative ….. and  I don’t know whether that change came before or after she started hiking the Pacific Coast trail.  I don’t think it matters. 

What I do know from the book and what I do think matters is the fact that she wasn’t just telling herself “Bravery now!” Jerry Costanza style and magically became brave enough and strong enough to solo hike the Pacific Coast trail. 

Rather, her narrative shift was paired with both her past struggles and present reality of the hiking experience.  She connected deeply with the fact that she felt unsafe, weak and scared AND used her experience solo hiking the Pacific Coast trail to reinforce the new narrative.  Only by doing both could she move from just telling herself a story to embodying her new narrative of safety, strength and bravery…literally changing her body and behavior.

While Strayed had some pretty intense physical pain and emotional trauma, many can relate.

“I’m sick again,” “I’m broken,” “I’ll never feel well.” These aren’t just thoughts. They are the narrative – the story – we are telling ourselves and our bodies each day.

So how do we make sure we embody a narrative that reflects the person we want to be?

I think we follow Cheryl Strayed’s lead: (1) create honest awareness about how we feel and (2) identify what we really want.  If we have those two in place, we can engage intentionally with experiences that acknowledge where we are and help us embody the narrative that we want to be. 

Acupressure or Trigger Point? Tomato or Tomatoe?: what you really need to know about soft tissue techniques and picking a good bodyworker

I’ve completed training in a variety of soft tissue techniques ranging from Active Release Therapy (“A.R.T”) – which is a form a fascial work, to neuromuscular (Trigger Point) therapy, and acupressure.

During sessions with new clients, I’ve noticed that I tend to get a common set of questions: what technique is that?  Was that trigger point therapy or acupressure?  Which one do you think is more effective?

Clients get hung up on the technique and it’s understandable….because bodyworkers do too.  Bodyworkers market themselves as “The Trigger Point Guy”, the “Myofascial Lady” or the “Acupressure Guru”.  These therapists market the hell out of a certain technique, touting the nirvana that awaits if you could only experience the magic that can be unleashed by [INSERT TECHNIQUE HERE].   

Only after [INSERT TECHNIQUE HERE] will you run pain free like Usain Bolt and feel as calm as the Dalai Lama. 

Why wouldn’t clients be focused on the technique when that seems to be all they hear in the advertising around bodywork and pain relief?

So, let’s address one of those questions because it will help us remember that these techniques are not magic – they are simply tools and the focus needs to be on the therapist and how they use their tool kit.

 

Acupressure and Trigger Point Therapy: Apples and Oranges or Tomato, Tomatoe?

So when someone asks me, is that trigger point therapy or acupressure?

My answer is always the same: Yes.

And after they look at me like this:

I explain that I’m not just messing with them or being a jerk. 

Sometimes it’s really hard to tell.  Here’s why.

For the uninitiated, here’s a short description of Trigger Point therapy and Acupressure.

Trigger point therapy:

is a manual technique focused on Trigger Points, which are tiny areas of irritation within the muscle that form as a result of an individual’s accumulated experience through movement, posture and tension.  Trigger Points have common locations and pain referral patterns across individuals.  These patterns help therapists identify the true source of the pain, locate the Trigger Point and facilitate a release.

Acupressure:

is a technique using finger pressure on acupoints, which are located on meridians. Meridians are a network of channels that transport Qi (i.e. energy), and acupoints are places along the meridians where the Qi is accessible through touch. Acupoints have common locations along the meridian system as well as common patterns of symptoms like pain, discomfort, and tension associated with the particular point and meridian.  These patterns help therapists identify the source of pain and discomfort and facilitate a release and rebalancing of the soft tissue and energy system.

 

It seems like they’re pretty different.  One theory talks about referral pain patterns, one talks about energy pathways.  One says trigger point, one says acupoint.  One is from the Western, clinical tradition.  One is from the Eastern, holistic tradition.

I think it’s a much more of a case of Tomato, Tomatoe than Apples and Oranges.

Why?  They are techniques focusing on point specific work designed to help relieve pain and tension in the human body, and the human body just doesn’t change all that much from East to West.

But don’t just take my word for it.

If you put up a map of trigger points and a map of acupoints, the overlap is incredible.  The overlap happens with both the locations of the points and the patterns found in pain referral patterns and meridians.

Here some examples that you can see for yourself. 

 

Neck and Shoulders

In the picture below, take a look at image on the right.  The “X” indicates the trigger point in the upper trapezius muscle and you see the red colors that map the pain referral pattern that moves into the neck and head.  I bet most of you have felt this at one point or another. 

Now compare it to the image on the left.  That upper trap trigger point sits right on the point 21 in the Gallbladder meridian.  And the pain referral pattern follows the gallbladder meridian path around the ear to the lateral corner of the eye.[1]

Trap-gallbladder similarity.jpg

Legs

In the picture below, take a look at the image below.  You’ll see two “Xs” indicating the location of the trigger points in the quadriceps muscle known as the Vastus Medialis. 

 

Now look at the picture on the below.  Look at the points labeled SP 10 and SP 11 on the picture – these are points on the Spleen meridian.  Once again you see the overlap.  The location of the trigger points in the vasutus medialis are the same as the acupoiunts in the Spleen meridian, and the trigger point pain referral patterns follow the path of the Spleen meridian.

The overlap doesn’t just occur in these two spots – it’s pervasive.  In fact, a clinician from the Mayo Clinic found that there was a 92% overlap in where Trigger Points and acupoints are found on the body.[1]

So, if I’m holding a point in your upper trap, and you ask me: is this Trigger Point therapy or acupressure? You have a better idea of why I answer “Yes.”

Before I say QED[2] and drop the microphone….you may be saying to yourself: interesting, but so what?  What do I do with that information?

Great question.

Here’s how I think you can use this information

You’ve seen the overlap between trigger point therapy and acupressure.  We could have just as easily done the same comparison with myofascial work and A.R.T.

If there are so many similarities between these techniques, does that mean you should expect the same results from each?

No. 

No more than you should expect to get the same results if you handed the same paintbrush to me and Van Gogh and asked us to paint the stars in the night sky.

It’s all about the skill, mastery and experience working with that tool.

AND it’s not just about the person painting.  The artist isn’t magical either. It’s also about what you bring to the experience: your history, your preferences and goals.  You may prefer photographs or Picasso to Van Gogh.  

The same goes for bodywork.

The skill, experience and mastery of the bodyworker do matter, and so do you.  You’re a living being, with preferences, experience and goals that you bring to each session. 

The key is not just the technique or the practicioner or you….it’s how all of those things come together in a session. 

Because of that dynamic, the best bodywork I’ve received has come from practitioners who focus on their philosophy of practice rather than a specific technique.  They focus on how they work with individuals, the healing process, the role of pain and how to help them work together towards healing.  That is what they did with me and that is where magic can happen.

These types of practitioners often have training in a broad range of techniques to help them accomplish that, and their mastery is in how they seamlessly integrate a variety of techniques within a single session based on the client’s goals, preferences and how their body is responding.  The technique is there.  It is a tool they use; but it is always secondary. 

That approach also fundamentally changed how I saw the healing process and experienced bodywork….for the better. 

When I stopped looking for a magical cure from a technique or a bodyworker, I started to become more attuned with my body and the healing process itself.  The fact that healing was a process – not a switch to be flipped.  The importance of getting in sync with my body – like when I felt better and why rather than laying it at the feet of the bodyworker or some technique.  That paradigm shift and understanding of the process helped deepen and accelerate my healing.    It also helped me become a lot less frustrated because I stopped looking for the silver bullet that didn’t exist. 

Drawing on that experience receiving bodywork and an understanding about how much some of these techniques overlap, I have tried to model my practice on the same principles.   

My clients know that no two sessions look or feel the same.  In one session, we may only do acupressure and in another we may integrate acupressure, A.R.T. trigger point work and Swedish massage…it all depends on where the client is in the healing process (e.g. moving from an acute pain phase to one of mild ache and transition back into training), what the client’s goals are that day and how their body is responding.

I’ll leave it to my clients to tell you the level of skill and mastery during those sessions and how effective they find it. 

 

So when you’re looking for bodywork – here’s my recommendation:

Don’t worry as much about the technique.  Instead, look for someone who has a clearly articulated philosophy on the healing and recovery process.  Look for a philosophy that resonates with you and that is based on something broader than just a single technique. There’s no magic in these techniques.  They’re only as effective as the people who use them and the approach they and the client bring to each session.

QED ;)

[1] Dorsher PT (May 2006). "Trigger points and acupuncture points: anatomic and clinical correlations". Medical Acupuncture 17 (3).  Dorsher PT (July 2009). "Myofascial referred-pain data provide physiologic evidence of acupuncture meridians". J Pain 10 (7): 723–31.

[2] You’re welcome all you math nerds ---- "Q.E.D." (sometimes written "QED") is an abbreviation for the Latin phrase "quod erat demonstrandum" ("that which was to be demonstrated"), a notation which is often placed at the end of a mathematical proof to indicate its completion.  Definition from mathworld.wolfram.com/QED.html

 

[1] Image from http://www.positivehealth.com/article/chinese-medicine/acupuncture-east-meets-west

Find a happy place: what visualization, Jim Carey and kettlebell presses all have in common

Before starting my therapeutic bodywork practice, when people talked about visualization, I thought of two things: Buddhist monks and Jim Carey....sometimes all rolled into one

 

Some people were zealots about visualization, others were skeptics.  Since I didn’t have experience with it, I didn’t know what to make of it.  That was the case until two things happened: (1) some new research came out and (2) I had some personal experience with it.

Recent neuroscience research has helped show how the body and mind work together.  That new understanding has helped me see how visualization may be used effectively as a tool to help create physiological change – both for myself and for my clients.

We’ll get into the research, but let’s start with experience rather than stay at the abstract.  

Here’s a personal example from practice that I think illustrates how this issue appears and how we can use visualization to address it.  This happened this week while working with a client I will call Steve.

Steve had come in primarily for shoulder mobilization and stabilization work.  We had done a lot of bodywork to open his shoulder and incorporated some strength exercises like kettlebell presses to help create stability around the shoulder joint.  It was, for most people, the typical way they change the physiology of their body – combine bodywork with exercise to open and strengthen the tissue.

Steve came in very stressed out. He sat in the chair, buried his face in his hands, and said, “I’m just exhausted.  I don’t think I have the energy to do any work today.”  He proceeded to tell me what set him off.  He’d been in intense meetings all day  - meeting with clients, his boss, and then people he supervised.  It had been non-stop.  He’d managed to get through the day well until he walked back, mentally exhausted, into his office and saw something that pushed him over the edge. 

Before getting on the table, he agreed to play along in an exercise, so I asked him to go through the following visualization.

First, I asked him to get a clear visual of the stress and describe what that felt like in his body when he felt “pushed over the edge”.

-       He felt his stress tip over the edge as he walked into his office and saw a desk full of papers, the red light on his phone blinking with unanswered messages, and then he heard the dreaded Outlook “bing” that signals new e-mail was hitting his Inbox.  It was clear work had been piling up all day and he would have several hours just to dig out of the backlog. 

-       He said then he felt completely overwhelmed with work and that his body just shut down.

-       He described the “shut down” feeling like his heart was racing, he was breathing shallowly into his chest that caused a clenching in his chest; and

-       He felt tense all throughout his neck and jaw. 

With that image clearly in his mind, I asked him to imagine a time when he felt incredibly relaxed and without burdens.  Once he thought of an experience when he was relaxed, I encouraged him to get as detailed as possible connecting with each detail and remembering what it felt like.

For Steve, he went back to the trip he took right before his first child was born.   He and his wife were on a beach in Hawaii.  Among other sensations, he described

-       the warm, blond grains of sand moving through his toes as he sat in a beach chair and dug his feet in and out of the sand;

-       the soft, gentle rhythm of the waves breakingoff the coast, and

-       the condensation from the cold glass that held his cocktail dripping down the outsides of his fingers.

After he felt he had fully described the image, I asked him to notice what was happening in his body… he described what I could see externally, which included

-       His heart rate had slowed down

-       He was breathing more deeply and into his stomach rather than just up into his chest

-       He felt cooler (for me his face was no longer flushed)

-       He smiled for the first time since entering the office and his jaw had relaxed.

 

At this point, the skeptics kick in and think…..riiiiiiiight. Why would an image from ten years ago actually have a real, physiological affect on his body now?

 

It’s a great question.  Before this neuroscience had access to visual imaging like fMRIs, there wasn’t much access to the how and why.  People would have to take that story on faith that Steve’s body actually changed and either remained believers on faith and experience, or skeptics.

 

Here’s what happens in our bodies.

Everywhere we go, our minds and bodies create maps – essentially charting where we are, how we got there, what the place is like, etc.  Those maps are stored in our memories to help us navigate the world safely and efficiently (this is the way to my house; this neighborhood is dangerous at night; etc.). 

When we think of memory, we typically only think of the image - like a 2-D visual of an event in our lives.  While our memories can include visual images, they also contain imprints of our physiological and emotional states present during that memory.  In other words, our memories include time, place and what our bodies felt like at the time those memories occurred.  As a result, our brain links an emotional and physical condition with the event.  All of that becomes part of the memory.

So, when Steve enters that messy office his mind and his body are mapping the environment.  Sensory information tells him he has tons of work to do (red light, piles of paper, email sounds) and he feels the stress associated with that backlog of work.  His memory of that experience includes the visual image, place and that feeling of extreme stress.

 

How does a memory include time, places and feelings?

In all of our brains, including Steve’s, the hippocampus plays a major role in creating those maps and the memories that go along with them.  Among other functions, the cells within the hippocampus play a vital role in spatial navigation (literally, where we are, where we were, and how we got there) as well as the creation of memory (both long and short term).  The hippocampus does not, however, work alone.

The hippocampus is located in the limbic system, which is called the emotional center of our brain.  The limbic system contains key structures that help us process and become aware of feelings and emotions.  Within the limbic system, the hippocampus sits next to the amygdala, which plays a particularly important role in controlling how we respond to stressful and fearful situations.

 

 image from humanillness.com

image from humanillness.com

As a general rule of thumb in neuroscience, structures that are close together in the brain often work together since the communication lines are short and efficient.  The hippocampus follows this rule.

The hippocampus directly communicates with its neighbor, the amygdala as well as the hypothalamus, which helps coordinate our body’s automatic physiological responses to a stimulus whether it’s stress (that triggers a fight or flight response i.e. rapid breathing, increased heart rate) or peace (that triggers decreases in breathing, heart rate and muscle tension)).

As a result, this little neighborhood in the limbic system works together to create detailed maps that become part of our short and long term memory.  These memories include highly detailed and visual images of the time and place, as well as imprints of what we felt like physically and emotionally. In fact, the stronger the emotion (both positive and negative), the more vivid and detailed the memory. [1]

 

Why would the mind and body work this way?

One of the major reasons is to help us survive. 

This process happens on an unconscious, automatic basis that doesn’t involve rational thought or intentional decision-making.  That’s an incredibly adaptive and useful response that has helped countless generations survive pretty tough environmental and social conditions. 

Survival may seem dramatic in Steve’s situation, so let’s ground it in something more extreme but still realistic. 

Imagine walking down your street and your neighbor’s dog is barking at you aggressively and swatting at the fence.  Suddenly, the fence breaks and your neighbor’s dog attacks you.  You hold up your arms to defend yourself and the dog bites your arm. You have to go to the hospital to get stitches and shots.

The next time you see that dog your body will almost certainly respond with fear and the physiological response typical of the sympathetic nervous system – that fight or flight response that includes shortness of breath, increased heart rate, etc. [2] The dog hasn’t attacked you again, but your mind and body remember the scene, understand the this dog is likely to attack, and put you on high alert to protect against another attack – heart rate elevated, muscles tense and ready to run or fight off an attack as you walk quickly by the fence.  It’s a coordinated effort between the mind and body (images, emotions, and physiological changes) to help you protect yourself.

There are two interesting, additional elements about how our memory affects our physiology.

First, brain scans have shown that your body will provide the same stress response by simply recalling that event– you don’t even have to see the dog again in person.[3]  

Second, research has also shown that your friend would experience the same physiological changes (stress response) if you had simply told them the dog was dangerous – even if he had never seen the dog before.[4]

As a result, the memory or image alone can activate physiological change – even if the event is in the past OR we’ve never actually experienced the event ourselves.

While we may wish the sound of our Inbox filling didn’t increase our stress hormones (and this study shows that it can do just that by increasing cortisol levels[5]), it’s a good thing we have this mechanism.  We probably wouldn’t be here if our ancestors went up to every saber-tooth tiger they saw to see if it was nice and wanted to play.  Thankfully, one guy made that mistake and then everyone who saw it went and told their friends.

You don’t have to face a saber-toothed tiger to see how this little hippocampus neighborhood alliance works.  I’d wager most of us have already experienced this phenomenon in mild form as we hear a song on the radio or drive past our old elementary school and experience images and feelings from our past – pleasant or stressful.

 

So what? Why should we care?

If we understand that our memories (working with our hippocampus and amygdala) have imprints of time, space, and feeling - literally how our body felt when we saw that dangerous dog or were sitting on the beach, then we can access the memories and that physiological state at any time.

That can be an incredibly powerful tool if we want to feel differently.  All we have to do is connect with a strong memory.

For Steve – this tool was used for stress relief.

That visualization helped him slow down his breathing and heat rate and decrease muscle tension.  It was as important in creating physiological change in Steve’s body (heart rate, breathing, muscle tension) as those kettlebell presses were in creating stability in his shoulder. 

You can imagine that this doesn’t just work for stress relief.  Others may want to pump themselves up – (like right before a game or a race)....or be the best Pet Detective they can be...

 

 

The point is that powerful experiences and memories are inside each one of us.  The more fully and deeply we can connect with these memories to regain that body-felt sense of the experience, the more powerful those memories can be in initiating physiological changes we’re looking for.

 

Resources/Citations

[1] Phelps, Elizabeth A. "Current Opinion in Neurobiology 2004, 14:198–202." pg. 199. Also found here (http://www.psych.nyu.edu/phelpslab/papers/04_CON_V14.pdf

[2] Ibid, pg. 200.

[3] Van der Kolk, Bessel. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, pg. 95.

[4] Phelps, Elizabeth A. "Current Opinion in Neurobiology 2004, 14:198–202." pg. 200. Also found here (http://www.psych.nyu.edu/phelpslab/papers/04_CON_V14.pdf

[5] http://www.profjackson.com/email_stress.html