Bow down to the all mighty psoas

Let’s do an exercise. Identify the following muscles in your body, move them, think about how they feel when they’re functioning well compared to the feeling when they’re tight, impaired or injured. Ready? Here we go.

Bicep. No brainer. Do your best body builder pose. Got it?

Calf. Raise up on your toes and feel it contract. Put on some high heels. Maybe it bulges out of the back of your leg, maybe not. Ok, moving on.

Abs. Where’s that six pack? The goal of many a workout. Situps. Lots and lots of situps.

Ok ready for the next one?

Psoas. 

Huh?? What is it? How do you even say that?

Psoas. C’mon, flex it. Now relax it. Stretch it.

But how do you feel it? What does it do? And seriously, how do you pronounce that?

Psoas muscle

Psoas muscle

For many of us, the psoas is a mystery muscle. Most people (yoga addicts, pilates gurus, and fitness fiends aside) have no idea what it is or what it does. From what I’ve learned, it’s only been in the last couple of decades that it’s even reached modest levels of significance.

For me, the connection to my psoas was badly damaged during my injury. Although I’ve regained decent connections to my glutes, quads and hamstrings, and gradually but consistently strengthened my abdominals and core muscles, my ability to use my psoas has eluded me.

Why does this matter? How important can the psoas be?

Extremely important, it turns out.

The psoas is the only muscle that connects the spine to the lower body. It originates in the low back, branching out from the 12th thoracic and all five lumbar vertebrae, sloping down underneath all of the abdominal core muscles, through the pelvis and attaching to the top of the thigh bone. It’s responsible for many things including but not limited to trunk stability, low back flexibility, picking up your leg to take a step, supporting organ function and even breathing. Functionally, one of the reasons we have evolved to standing from being on all fours is the emergence and importance of the psoas.

I’ve known for some time now that strengthening my connection to my psoas is maybe the most essential next step in my recovery, since with even moderate engagement, I would be able to lift my leg and swing it through to take a step.

What I didn’t realize however, was just how significant this muscle is not only functionally and physically but emotionally. As one of the deepest muscles in the body, and as a literal bridge from the trunk and abdomen to the legs and lower body, its importance can’t be understated. Additionally, the psoas is connected (via fascia and connective tissue) to the diaphragm, which is responsible for breathing.

So a quick summary: we’re talking about a single muscle that’s largely involved in walking, keeping your entire trunk and lower spine stable, keeping you alive (by allowing you to breathe), and helping your organs work effectively.

It should come as no surprise then that as soon as I started aggressively targeting and working this muscle in the last week, all kinds of things got stirred up within me. Emotions were whirling at me from nowhere, deep fears were conjured up, and everything within me felt kinda topsy turvy.

Although I had previously heard of the emotional importance of the psoas in particular and the core as a whole (some spiritual practices believe that your soul resides deep in your belly), I honestly didn’t really buy it. Now I admit I was wrong and fully succumb to the power and influence of the psoas.

So be nice to your psoas, stretch it and pay attention to it, cause chances are you have no idea how important it is.

A repetition is an event

“Remember Ar-aaaash, make every repetition a separate event.”

These were the words, expressed in his slow, charming Alabama drawl, of one of my trainers a while back during a rather challenging exercise. He was a corky guy, eccentric yet affable, and I probably only worked with him a handful of times, but he had an eclectic knowledge of the body and liked to share his experience which was largely based on his years as a professional body builder.

He said that when it comes to many repetitive exercises, most people think only about completing the desired number of repetitions. Instead of that approach, he suggested that it’s not important whether you’re doing six, ten, or twenty repetitions but that you shift the focus from the completion of the entire set to an intense concentration on each repetition as its own end goal.

Clearly, the idea of “making each repetition count” wasn’t a new one at all, but the way he expressed it, his suggestion to think of each as an “event,” resonated with me.

The reason I’m thinking, and writing, about this now is that I’ve reached a point now in my rehabilitation where this advice is especially useful. In the last couple of months, much of what I’m working on has been extremely specific, focused and calculated exercises targeting small muscles and newly established and still weak neurological connections. These aren’t movements I can just complete unconsciously or with minimal attention. Now, I have to concentrate more than ever to turn on certain muscles, turn off other muscles that want to take over and dominate the movement and give every ounce of mental energy I have to try to strengthen a dormant or underutilized neurological connection.

After all this time, it’s still really hard for me to describe what it feels like to deal with a damaged neurological system.

It’s not like anything I ever experienced before my accident. It’s nothing like being on a long run or bike ride and battling complete exhaustion to fight through to the end. It’s not like being in a weight room and challenging a previous feat by adding a heavier weight, gritting your teeth and muscling through the movement. Nor is it like getting into a challenging yoga pose and trying to contort your body into a pretzel-shaped position.

I have to concentrate so much more on each specific aspect of my movement because I’m not only engaging the muscles that I do have control of, but I’m trying to reestablish those damaged connections. That’s why treating each repetition as a separate event is such great advice. It slows the entire process down, demands tremendous brainpower and forces me to prepare, complete and analyze each repetition with focus and determination. I also like that it can be applied to any repetitive movement or practice, not just physical exercise and it allows me not to take any practice for granted. Slowing down and treating each repetition as its own event can only benefit my continued recovery.

On cures

There have been some innovative and very high profile developments in the last few months when it comes to treatments for Spinal Cord Injury (SCI). Scientists, researchers, and advocates have demonstrated that creative approaches can lead to exciting and potentially groundbreaking results in treating this oh so complex injury, which no one seems to really, truly understand.

I’m often asked how excited I am about these breakthroughs and what they could mean to my own recovery and although my usual, quick answer is, “Yeah, it’s pretty cool. Lots of interesting things happening these days,” I figured I’d use this blog post to expand and clarify my true feelings.

If you have no idea what I’m talking about, I’ll quickly outline and link to the three major developments that have come out just this year.

1) Epidural Stimulation - By implanting a small device over the protective coating of the spinal cord, and sending varying electrical currents to activate nerve circuits, four initial participants (all having suffered severe SCI’s) were able to achieve some motor control in their lower body as well as regain some other essential bodily functions.

2) Olfactory Stem Cell Implants – Scientists in Poland and the UK removed a man’s olfactory ensheathing cells (specialist cells from his nose that form part of the sense of smell), grew them and then injected them into his spinal cord to repair the damaged nerve fibers. Six months after surgery and with hundreds of hours of exercise and therapy, he slowly regained the ability to walk with braces.

3) Proteoglycan Drug – A neuroscience professor in the Ohio developed a drug that releases nerve fibers that have become trapped in scar tissue after a spinal cord injury, thus bridging the damaged cord and restoring some function. The study was conducted on rats but they’re quickly planning on trying it on humans.

Now that we’re all caught up and on the same page, I’ll explain my thoughts on these developments starting with the big positives and reasons I’m excited, but then also sharing   why I’m cautious and skeptical.

First of all, I’m thrilled that more people are paying enough attention to this injury to come up with long-term projects to address it. A scientist behind the second story I mentioned above was quoted as saying that this development was “more impressive than man walking on the moon”. I couldn’t agree more.

Secondly, the fact that these three developments all used different methods gets me excited. If they were all stories about stem cells or a medicine of some kind, I would be more skeptical of having all the eggs in one basket. Then, if something negative or ineffective came out about that one approach, the whole thing could come crumbling down. Three different methods means that the damage to the spinal cord is being treated with three individual approaches that each have their advantages and shortcomings, but they’re all leading to results, which is incredible.

On a similar note, the diversity of approaches means that there could be a potential to combine solutions in the future. Maybe with some people the stem cell treatment is less effective but the Proteoglycan drug picks up the slack. Maybe none of the treatments on their own lead to dramatic improvements, but in combination with each other (and whatever new technologies arise) a person can bounce back nearly 100%! How amazing would that be??!

My final reason for excitement is because this topic is, for the lack of a better term, sexy. Curing paralysis is a BIG DEAL. Getting people out of wheelchairs and back on their feet is truly earth-shattering. As someone who would give ANYTHING to regain function the way I had it before my injury, I can honestly say that no other medical breakthrough gets me as fired up as this. I’m obviously biased, but I embrace it.

Now for my reasons for caution:

The time frame for any of these treatments to reach the masses is loooong. The first study was conducted on four people. The second, on one. The third was on rats. I know technology moves at a frighteningly and often surprisingly fast pace these days, but even by the most optimistic estimates, these treatments are a few years away from being available to the millions of people worldwide who would benefit from them.

The financial costs, both for developing these treatments and for receiving them in the future, are huge. As I mentioned above, curing paralysis is truly groundbreaking news, but unfortunately, there hasn’t been nearly enough investment in finding ways to do this. The reality is that SCI doesn’t affect as many people as cancer or diabetes or AIDS and while I wish I could say that it’s not a numbers game, everything I’ve read proves that it absolutely is a numbers game. When the Christopher Reeve Center (with millions of dollars of its own, which has been the dominant driving force in treating SCI) has to launch a big PR campaign (see the epidural stimulation link above) to raise funds in order to continue research, it shows just how underfunded and under-recognized treating SCI is.

On top of that, we have to assume that at least initially, any potential cure will likely have a high financial cost to the user, which will automatically limit the ubiquity of the treatment. At least in the US, where medical insurance is always trying to find ways NOT to pay for anything, I’m not hopeful that insurance companies would be on the cutting edge of promoting and paying for a splashy yet expensive cure, even for an issue as sexy and exciting as this one.

I’m not trying to be a Debbie downer about all of this, I truly am thrilled to see what the future holds, but I’m a pragmatist and realist at heart. The future is very exciting, but for someone like me, who suffers through day after day of frustration at not a fully functional body, I don’t have tons of patience to just look forward to the future. I want to do something now. I don’t plan on sitting around and waiting for someone else to solve my problem and I’m way too Type A and motivated to stand by and accept complacency or the status quo. For that reason, none of these developments changes a thing in my day to day routine. I’m still going to work as hard as I have been to recover through my own hard work and will.

The one thing that all of these scientific developments prove to me more than anything else, is that the existing paradigm and approach for treating SCI is outdated and just plain wrong. These ideas show that the antiquated yet predominant way of thinking, of taking away hope from someone, of telling them they’ll “never do this or that again” has to change. It was only a few years ago when no one in the medical community believed in neuroplasticity, or the ability for the brain or nervous system to repair or change itself. Now people are changing their minds faster than ever and accepting that as arrogant and all-knowing as we human beings think we are, we don’t always know the answers. That way we remain open to solutions as they come, and I’m fully confident that in treating SCI, the solutions will indeed come…

Levels upon levels and the big building of recovery

I’ve been thinking a lot recently about buildings. I’m no real estate mogul, and certainly no engineer, but I can’t stop thinking about a building and how it’s constructed from bottom up.

I think of a building in the midst of construction and the stages of development it goes through. More specifically, I think of the levels of a building. How they get built, one on top of the other, each level relying on those below it and the tallest level, stacked up on the rest, claiming the highest height for itself, until it’s replaced by the next level and it becomes a supporting member of the entire structure, just like its brethren below.

Whenever a new level is being built on a structure, be it a 2 story house or a multistory skyscraper, there is so much that goes into making sure everything below is secure before the next level can be completed. Under construction, a new level always looks so awkward, incomplete, and bare. It’s only once it’s finished that suddenly, everything looks right, it all makes sense again and pretty quickly, it’s hard to imagine that building without that added level.

I swear I’m going somewhere with this…

For the last few months, I’ve felt like a massive level has been under construction on my building of recovery. After a spring and summer where I had noticeable, small and large achievements on a seemingly consisten basis, it’s been a….how would I say it….interesting…time recently.

There haven’t been any major breakthroughs I can hang my hat on. I don’t have any big accomplishments to match some of the developments I had in the past, developments I could feed off of and rely upon to propel myself forward.

So I keep thinking of these levels being constructed in buildings and how crucial it is for everything below to be stable, strong and 100% reliable before the next level can be built. I figure that all of the hard work I’m doing now is laying the foundation (pun fully intended) for the next breakthrough. I tell myself that my upcoming accomplishment must be a good one, since it’s needing all of this extra time and attention in the construction phase before it can be completed and realized. I guess in my building metaphor, not all levels are created equal.

Some are constructed and completed soon after the previous ones, while others are those needy, complicated, annoying projects that need all of those extra materials and time before they’re ready to be finished.

I keep telling myself that I can’t stop now, that I’ve put too much time and effort over these last few months building and strengthening everything for the next major breakthrough, and that my hard work will be realized. I’m looking forward to that imminent moment, when the awkward looking phase is over, when the next level has been built and when I can look at the new construction and wonder how it could possibly have existed any other way. Yeah, I’m ready for that moment to come…

Drip drip drip

On a recent warm and sunny Indian Summer day, I was sitting outside when I noticed a dripping on my shoulder. There was no way it was coming from the cloudless sky above so it quickly became apparent that the sweat was dripping off my head, naturally moisturizing my neck and shoulder.

Early on after my injury, I wrote a post about the very first beads of sweat I experienced and how significant that had been so with this recent development, I figure it’s time to reexamine this vastly under appreciated bodily system.

One of the many, and I mean MANY, secondary complications of a Spinal Cord Injury (SCI) is the deficiency in body temperature regulation. Simply put, the nerves in the spinal cord that control perspiration to various parts of the body are damaged thus leading to a decrease or inability to perspire. Similarly, when a person with a SCI gets too cold, it may be very time consuming and challenging for them to warm back up. The comfortable range of temperature for someone with a SCI is a lot more limited than it used to be. As you could imagine, this can lead to many challenging situations and unanticipated planning.

In the 18 months since I wrote that last post, my ability to handle more extreme weather has dramatically improved. I remember my feet used to turn to ice blocks at night, even in warm settings, because of the lack of circulation. Sitting in the sun for more than a few minutes was just asking for hours of suffering, as my bone dry skin wouldn’t naturally cool down the rest of my body.

I can’t say that I’m anywhere near where I’d like to be but the sweating and the temperature regulation as a whole has improved dramatically. Strangely enough (or not so strange if you know a bit about the left-right imbalance that comes with SCI, stroke, and other neurological injuries), I sweat much more out of the right side of my body than my left. I no longer have to rely on a physically intense workout to get a decent sweat. If the weather is warm enough, the moisture will come out.

I have to credit swimming as one of the contributing factors to this. Getting in a pool a couple times a week and literally forcing my body to deal with a dramatic change in external temperature, only to transition again after getting out and showering, has made me more adept at regulating my body temperature. I haven’t yet been anywhere too cold so I don’t know if I feel as confident with that, but I’m sure I’ll discover that soon.

So the next time you sweat, don’t take it for granted. That extra layer of perspiration and body odor is what’s keeping your body functioning at its peak.

Oh the people you’ll meet…

For those of you Dr. Seuss fans, yes the title of this post is a play on the well-known story, “Oh the places you’ll go!” and it’s so relevant to all of the people I’d like to acknowledge in this post.

It’s easy to dwell in the negativity of all of the things I cannot do right now due to my injury. Every single day, I have to actively make an effort not to go down that path, not to get trapped by those “can’t” thoughts because all they bring me are negative emotions: resentment, envy, frustration, impatience, and distress. One thing that helps me through this process is appreciating all of the incredible people that have come into my life as a result of this injury.

In the last two years, despite dealing with the most vulnerable and trying circumstances, fighting so hard for every little accomplishment, I’ve been blessed to have met individuals who have impacted me positively and consistently raised my spirits. I’ve encountered genuine, passionate and optimistic people who have shown they are as committed to helping me achieve my goals as I am.

I have trainers and therapists who prove to me every week that they believe in my objectives and they’re willing to go out of their way to learn more about my injury and how to treat it. They illustrate their passion and excitement to me all the time and they go above and beyond their responsibilities in order to match my great expectations. They read books, watch videos, question their own habits and practices and try new things with me. They do it not because they should, not because they want to humor me or pity me, but because they genuinely care.

There are friends who volunteer their time, energy and professional expertise to help fill the holes of a medical system that has abandoned me. Friends who work full-time, yet sacrifice their Sunday mornings to show up and do core strengthening exercises in my living room. Friends who meet me every week for swim sessions, helping me get stronger and fitter in the pool in ways that I can’t do on land. Friends who donate their healing abilities to give me acupuncture treatment so that my sore and overused muscles can get a much needed respite from the rigors of everyday living. Friends who are willing to travel across an ocean with me so that I can have access to the best therapy I have found. Friends who donate their time to organize fundraising events so that I can continue doing therapy. Friends who encouraged me to start writing and sharing my story with the world. Friends who – before I could drive myself – would get up early and drive me to rehab, spending the entire day waiting for me and then drive me home.

Some of these people I’ve met since my accident, others I had known previously, but my friendships with them deepened. The common thread between all of these people is that my respect and admiration for all of them has hit stratospheric heights.

They’ve shown me that in an increasingly complex world, amidst a “reality-show” generation which popularizes and promotes tremendous levels of superficiality, banal cruelty, and obnoxious self-centeredness, there are people who rise above, who show up, who unwaveringly prove that there is still plenty of kindness, compassion and selflessness to be found.

You know who you are, and I’m grateful to you all.

Stand up and deliver

I’d like to share an incredible announcement with all of you. This past weekend, on the shores of beautiful Lake Tahoe, with the mountains that I grew up visiting through all my childhood in the background, and on a gorgeous late summer afternoon, I stood up on my own in a walker, and asked my amazing girlfriend Brita to marry me.

After realizing that I wasn’t joking, she shook aside the surprise and disbelief, stood next to me, eye to eye (a position we have only recently been able to enjoy) and said YES.

As all of you know, the accident that I suffered two years ago tragically changed my life and forced me to enter a world I had never expected. My career, my physical abilities, my independence and everything I had known until then were thrown into limbo with no explanation or resolution that any of it could come back to me or improve in any way possible. However, my ability to love, be loved and recognize the qualities of a truly one of a kind person were not compromised.

Brita and I (being introduced on an old-school blind date) had only met four months before my Spinal Cord Injury, which occurred while she was abroad finishing her graduate studies. When she came back to the US and saw me in the hospital, I immediately told her that I gave her full approval to move on from me, that this situation was going to be so incredibly arduous and challenging (and I didn’t even know the half of it….) that I had zero expectation or resentment towards her if she chose to let our relationship go. She had a green light….and she didn’t take it. She shook her head and emphatically and unhesitatingly told me that she wasn’t going anywhere, that she was in it for the long haul.

Throughout this time, she has been the biggest source of support for me, constantly listening to my rants and frustrations, praising my accomplishments and unequivocally maintaining the faith that I will get back on my feet, even when I question my own faith and hope. I truly believe that because of this experience, we have gotten to know each other on an entirely different level, and that’s why I had no hesitation that I wanted her to be my partner for life.

I had held a secret for the last few months that I shared with no one. I told myself that once I could stand, I would propose to this beautiful woman. Well the secret is out. It means so much to me to be able to have done this standing up, at eye level, and with the confidence that the hard work I’ve put in the last two years has paid off.

I’ll stop there as I could go on forever, but a big thanks to all of you who have supported me through this time. I’m honored to share this with you. And a huge thank you to everyone who helped me plan this special day and for our friends who were there that day, hiding in the trees and taking photos from afar and making this a truly memorable moment.

Much love and gratitude

Standing proposal