Freeing the neck and shoulders*

Stress, incorrect posture, poor vision and not knowing how to relax may all contribute to neck and shoulder tension.   More than 30% of all adults experience neck pain and 45% of girls and 19% of boys 18 year old, report back, neck and shoulder pain (Cohen, 2015; Côté, Cassidy, & Carroll, 2003; Hakala, Rimpelä, Salminen, Virtanen, & Rimpelä, 2002).  Shoulder pain affects almost a quarter of adults in the Australian community (Hill et al, 2010). Most employees working at the computer experience neck and shoulder tenderness and pain (Brandt et al, 2014), more than 33% of European workers complained of back-ache (The European Agency for Safety and Health at Work, 2004), more than 25% of Europeans experience work-related neck-shoulder pain, and 15% experience work-related arm pain (Blatter & De Kraker, 2005; Eijckelhof et al, 2013), and more than 90% of college students report some muscular discomfort at the end of the semester especially if they work on the computer (Peper & Harvey, 2008).

The stiffness in the neck and shoulders or the escalating headache at the end of the day may be the result of craning the head more and more forward or concentrating too long on the computer screen. Or, we are unaware that we unknowingly tighten muscles not necessary for the task performance—for example, hunching our shoulders or holding our breath. This misdirected effort is usually unconscious, and unfortunately, can lead to fatigue, soreness, and a buildup of additional muscle tension.

The stiffness in the neck and shoulders or the escalating headache at the end of the day may be the result of craning the head more and more forward or concentrating too long on the computer screen. Poor posture or compromised vision can contribute to discomfort; however, in many cases stress is major factor.  Tightening the neck and shoulders is a protective biological response to danger.  Danger that for thousands of years ago evoke a biological defense reaction so that we could run from or fight from the predator.  The predator is now symbolic, a deadline to meet, having hurry up sickness with too many things to do, anticipating a conflict with your partner or co-worker, worrying how your child is doing in school, or struggling to have enough money to pay for the rent.

Mind-set also plays a role. When we’re anxious, angry, or frustrated most of us tighten the muscles at the back of the neck. We can also experience this when insecure, afraid or worrying about what will happen next. Although this is a normal pattern, anticipating the worst can make us stressed. Thus, implement self-care strategies to prevent the occurrence of discomfort.

What can you do to free up the neck and shoulder? 

Become aware what factors precede the neck and shoulder tension. For a week monitor yourself, keep a log during the day and observe what situations occur that precede the neck and should discomfort. If the situation is mainly caused by:

  • Immobility while sitting and being captured by the screen. Interrupt sitting every 15 to 20 minutes and move such as walking around while swinging your arms.
  • Ergonomic factors such as looking down at the computer or laptop screen while working. Change your work environment to optimize the ergonomics such as using a detached keyboard and raising the laptop screen so that the top of the screen is at eyebrow level.
  • Emotional factors. Learn strategies to let go of the negative emotions and do problem solving. Take a slow deep breath and as you exhale imagine the stressor to flow out and away from you. Be willing to explore and change ask yourself: “What do I have to have to lose to change?”, “Who or what is that pain in my neck?”, or “What am I protecting by being so rigid?”

Regardless of the cause, explore the following five relaxation and stretching exercises to free up the neck and shoulders. Be gentle, do not force and stop if your discomfort increases. When moving, continue to breathe.

1. WIGGLE. Wiggle and shake your body many times during the day.  The movements can be done surreptitiously such as, moving your feet back and forth in circles or tapping feet to the beat of your favorite music, slightly arching or curling your spine, sifting the weight on your buttock from one to the other, dropping your hands along your side while moving and rotating your fingers and wrists, rotating your head and neck in small unpredictable circles, or gently bouncing your shoulders up and down as if you are giggling. Every ten minutes, wiggle to facilitate blood flow and muscle relaxation.

2. SHAKE AND BOUNCE. Stand up, bend your knees slightly, and let your arms hang along your trunk.  Gently bounce your body up and down by bending and straightening your knees. Allow the whole body to shake and move for about one minute like a raggedy Ann doll. Then stop bouncing and alternately reach up with your hand and arm to the ceiling and then let the arm drop. Be sure to continue to breathe.

3. ROTATION MOVEMENT (Adapted from the work by Sue Wilson and reproduced by permission from: Gorter, R. & Peper, E. (2011). Fighting Cancer- A Nontoxic Approach to Treatment).

Pre-assessment:  Stand up and give yourself enough space, so that when you lift your arms to shoulder level and rotate, you don’t touch anything. Continue to stand in the same spot during the exercise as shown in figures 1a and 1b.

Lift your arms and hold them out, so that they are at shoulder level, positioned like airplane wings. Gently rotate your arms to the left as far as you can without discomfort. Look along your left arm to your fingertips and beyond to a spot on the wall and remember that spot. Rotate back to center and drop your arms to your sides and relax.

 

Figure 1Figures 1a and 1b. Rotating the arms as far as is comfortable (photos by Jana Asenbrennerova)

Movement practice. Again, lift your arms to the side so that they are like airplane wings pointing to the left and right. Gently rotate your trunk, keeping your arms fixed at a right angle to your body. Rotate your arms to the right and turn your head to the left. Then reverse the direction and rotate your arms in a fixed position to the left and turn your head to the right. Do not try to stretch or push yourself. Repeat the sequence three times in each direction and then drop your arms to your sides and relax.

With your arms at your sides, lift your shoulders toward your ears while you keep your neck relaxed. Feel the tension in your shoulders, and hold your shoulder up for five seconds. Let your shoulders drop and relax. Then relax even more. Stay relaxed for ten seconds.

Repeat this sequence, lifting, dropping, and relaxing your shoulders two more times. Remember to keep breathing; and each time you drop your shoulders, relax even more after they have dropped.

Repeat the same sequence, but this time, very slowly lift your shoulders so that it takes five seconds to raise them to your ears while you continue to breathe. Keep relaxing your neck and feel the tension just in your shoulders. Then hold the tension for a count of three. Now relax your shoulders very slowly so that it takes five seconds to lower them. Once they are lowered, relax them even more and stay relaxed for five seconds. Repeat this sequence two more times.

Now raise your shoulders quickly toward your ears, feel the tension in your upper shoulders, and hold it for the count of five. Let the tension go and relax. Just let your shoulders drop. Relax, and then relax even more.

Post-assessment.  Lift your arms up to the side so that they are at shoulder level and are positioned like airplane wings. Gently rotate without discomfort to the left as far as you can while you look along your left arm to your fingers and beyond to a spot on the wall.

 Almost everyone reports that when they rotate the last time, they rotated significantly further than the first time. The increased flexibility is the result of loosening your shoulder muscles.

 

4. TAPPING FEET (adapted from the work of Servaas Mes)

Diagonal movements underlie human coordination and if your coordination is in sync, this will happen as a reflex without thought. There are many examples of these basic reflexes, all based on diagonal coordination such as arm and leg movement while walking. To restore this coordination, we use exercises that emphasize diagonal movements. This will help you reverse unnecessary tension and use your body more efficiently and thereby reducing “sensory motor amnesia” and dysponesis (Hanna, 2004). Remember to do the practices without straining, with a sense of freedom, while you continue relaxed breathing. If you feel pain, you have gone too far, and you’ll want to ease up a bit. This practice offers brief, simple practices to avoid and reverse dysfunctional patterns of bracing and tension and reduce discomfort. Practicing healthy patterns of movement can reestablish normal tone and reduce tension and pain. This is a light series of movements that involve tapping your feet and turning your head. You’ll be able to do the entire exercise in less than twenty seconds.

Pre-assessment. Sit erect at the edge of the chair with your hands on your lap and your feet shoulders’ width apart, with your heels beneath your knees.

First, notice your flexibility by gently rotating your head to the right as far as you can. Now look at a spot on the wall as a measure of how far you can comfortably turn your head and remember that spot. Then rotate back to the center.

Practicing rotating feet and head. Become familiar with the feet movement, lift the balls of your feet so your feet are resting on your heels. Lightly pivot the balls of your feet to the right, tap the floor, and then stop and relax your feet for just a second. Now lift the balls of your feet, pivot your feet to the left, tap, relax, and pivot back to the right.

Just let your knees follow the movement naturally. This is a series of ten light, quick, relaxed pivoting movements—each pivot and tap takes only about one or two seconds.

Add head rotation. Turn your head in the opposite direction of your feet. This series of movements provides effortless stretches that you can do in less than half a minute as shown in figures 2a and 2b.

Figure 2Figures 2a and 2b. Rotating the feet and head in opposite directions (photos by Gary Palmer)

When you’re facing right, move your feet to the left and lightly tap. Then face left and move your feet to the right and tap.

  • Continue the tapping movement, but each time pivot your head in the opposite direction. Don’t try to stretch or force the movement.
  • Do this sequence ten times. Now stop, face straight head, relax your legs, and just keep breathing.

Post assessment. Rotate your head to the right as far as you can see and look at a spot on the wall. Notice how much more flexibility/rotation you have achieved.

Almost everyone reports being able to rotate significantly farther after the exercise than before. They also report that they have less stiffness in their neck and shoulders.

5. SHOULDER AWARENESS PRACTICE.  Sit comfortably with your hands on your lap.  Allow your jaw to hang loose and breathe diaphragmatically.  Continue to breathe slowly as you do the following:

  • Shrug, raising your shoulders towards your ears to 70% of maximum   effort and hold them up for about 10 seconds (note the sensations of tension).
  • Let your shoulders drop and relax for 10 to 20 seconds
  • Shrug, raising your shoulders towards your ears to 50% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
  • Let your shoulders drop and relax for 10 to 20 seconds
  • Shrug, raising your shoulders towards your ears to 25% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
  • Let your shoulders drop and relax for 10 to 20 seconds
  • Shrug, raising your shoulders towards ears to 5% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
  • Let your shoulders drop and relax for 10 to 20 seconds
  • Pull your shoulders down to 25% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
  • Allow your shoulders to come back up and relax for 10 to 20 seconds

Remember to relax your shoulders completely after each incremental tightening. If you tend to hold your breath while raising your shoulders, gently exhale and continue to breathe.  When you return to work, check in occasionally with your shoulders and ask yourself if you can feel any of the sensations of tension.  If so, drop your shoulders and relax for a few seconds before resuming your tasks.

In summary, when employees and students change their environment and integrate many movements during the day, they report a significant decrease in neck and shoulder discomfort and an increase in energy and health.  As one employee reported, after taking many short movement breaks while working at the computer, that he no longer felt tired at the end of the day, “Now, there is life after five”.

To explore how prevent and reverse the automatic somatic stress reactions, read Thomas Hanna‘s book, Somatics: Reawakening The Mind’s Control of Movement, Flexibility, and Health For easy to do neck and shoulder  guided instructions stretches, see the following ebsite:  http://greatist.com/move/stretches-for-tight-shoulders

References:

Blatter, B. M., & Kraker, H. D. (2005). Prevalentiecijfers van RSI-klachten en het vóórkomen van risicofactoren in 15 Europese landen. Tijdschrift voor gezondheidswetenschappen, 1, 83, 8-15.  

Brandt, M., Sundstrup, E., Jakobsen, M. D., Jay, K., Colado, J. C., Wang, Y., … & Andersen, L. L. (2014). Association between neck/shoulder pain and trapezius muscle tenderness in office workers. Pain research and treatment, 2014.

Cohen, S. P. (2015, February). Epidemiology, diagnosis, and treatment of neck pain. In Mayo Clinic Proceedings (Vol. 90, No. 2, pp. 284-299). Elsevier. 

Côté, P., Cassidy, J. D., & Carroll, L. (2003). The epidemiology of neck pain: what we have learned from our population-based studies. The Journal of the Canadian Chiropractic Association47(4), 284. http://www.pain-initiative-un.org/doc-

Eijckelhof, B. H. W., Huysmans, M. A., Garza, J. B., Blatter, B. M., Van Dieën, J. H., Dennerlein, J. T., & Van Der Beek, A. J. (2013). The effects of workplace stressors on muscle activity in the neck-shoulder and forearm muscles during computer work: A systematic review and meta-analysis. European Journal of Applied Physiology, 113(12), 2897-2912.

European Agency for Safety and Health at Work (2004). http://europa.eu.int/comm/employment_social/news/2004/nov/musculoskeletaldisorders_en.html

Gorter, R. & Peper, E. (2011). Fighting Cancer- A Nontoxic Approach to Treatment. Berkeley: North Atlantic.

Hakala, P., Rimpelä, A., Salminen, J. J., Virtanen, S. M., & Rimpelä, M. (2002). Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Bmj325(7367), 743.

Hanna, T. (2004). Somatics-Reawakening The Mind’s Control Of Movement, Flexibility, And Health Boston: Da Capo Press.

Hill, C. L., Gill, T. K., Shanahan, E. M., & Taylor, A. W. (2010). Prevalence and correlates of shoulder pain and stiffness in a population‐based study: the North West Adelaide Health Study. International journal of rheumatic diseases13(3), 215-222.

Paoli, P., Merllié, D., & Fundação Europeia para a Melhoria das Condições de Vida e de Trabalho. (2001). Troisième enquête européenne sur les conditions de travail, 2000.

Peper, E. & Harvey, R. (2008). From technostress to technohealth.  Japanese Journal of Biofeedback Research, 35(2), 107-114.

*I thank Sue Wilson and Servaas Mes for teaching me these somatic practices.


Enjoy sex: Breathe away the pain*

“After two and a half years of trying, ups and downs, and a long period of thinking it will never happen, it did happen. I followed your advice by only applying pressure with the cones while inhaling and at the same time relaxing the pelvic floor. We succeeded! we had “real” sex in the first time.”

Millions of women experience involuntary contraction of the musculature of the outer third of the vagina (vaginismus) interfering with intercourse, causing distress and interpersonal difficulty (ter Kuile et, 2010) or pain during intercourse (dyspareunia). It is estimated that 1 to 6% of women have vaginismus (Lewis et al, 2004) and 6.5% to 45.0% in older women and from 14% to 34% in younger women experience dyspareunia (Van Lankveld et al, 2010).  The most common treatment for vaginismus is sequential dilation of the vaginal opening with progressively larger cones, psychotherapy and medications to reduce the pain and anxiety. At times clients and health care professionals may be unaware of the biological processes that influence the muscle contraction and relaxation of the pelvic floor.   Success is more likely if the client works in harmony with the biological processes while practicing self-healing and treatment protocols. These biological processes, described at the end of the blog significantly affects the opening of vestibule and vagina are: 1) feeling safe, 2) inhale during insertion to relax the pelvic floor, 3) stretch very, very slowly to avoid triggering the stretch reflex, and 4) being sexual aroused.

Successful case report: There is hope to resolve pain and vaginismus

Yesterday my husband and I had sex in the first time, after two and a half years of “trying”. Why did it take so long? Well, the doctor said “vaginismus”, the psychologist said “fear”, the physiotherapist said “constricted muscles”, and friends said “just relax, drink some wine and it will happen”.

Sex was always a weird, scary, complicated – and above all, painful – world to me. It may have started in high school: like many other teens, I thought a lot about sex and masturbated almost every night. Masturbation was a good feeling followed by tons of bad feelings – guilt, shame, and feeling disgusting. One of the ideas I had to accept, later in my progress, is that ‘feeling good is a good thing’. It is normal, permitted and even important and healthy.

My first experience, at age 20, was short, very painful, and without any love or even affection. He was…. well, not for me. And I was…. well, naive and with very little knowledge about my body. The experiences that came after that, with other guys, were frustrating. Neither of them knew how to handle the pain that sex caused me, and I didn’t know what to do.

The first gynecologist said that everything is fine and I just need to relax. No need to say I left her clinic very angry and in pain. The second gynecologist was the first one to give it a name: “vaginismus”. He said that there are some solutions to the problem: anesthetic ointment, physiotherapy (“which is rarely helps”, according to his optimistic view..), and if these won’t work “we will start thinking of surgery, which is very painful and you don’t want to go there”. Oh, I certainly didn’t want to go there.

After talking to a friend whose sister had the same problem, I started seeing a great physiotherapist who was an expert in these problems.   She used a vaginal biofeedback sensor, that measured muscles’ tonus inside the vagina. My homework were 30 constrictions every day, plus working with “dilators” – plastic cones comes in 6 sizes, starting from a size of a small finger, to a size of a penis.

At this point I was already in a relationship with my husband, who was understanding, calm and most important – very patient. To be honest, we both never thought it would take so long.  Practicing was annoying and painful, and I found myself thinking a lot “is it worth it?”. After a while, I felt that the physical practice is not enough, and I need a “psychological breakthrough”. So I stopped practicing and started seeing a psychologist, for about a half a year. We processed my past experiences, examined the thoughts and beliefs I had about sex, and that way we released some of the tension that was shrinking my body.

The next step was to continue practicing with the dilators, but honestly –  I had no motivation. My husband and I had great sex without the actual penetration, and I didn’t want the painful practice again. Fortunately, I participated in a short course given by Professor Erik Peper, about biofeedback therapy. In his lecture he described a young woman, who suffered from vulvodynia, a problem that is a bit similar to vaginismus (Peper et al, 2015; See: https://peperperspective.com/2015/09/25/resolving-pelvic-floor-pain-a-case-report/). She learned how to relax her body and deal with the pain, and finally she had sex – and even enjoyed it! I was inspired.

Erik Peper gave me a very important advice: breathing in. Apparently, we can relax the muscles and open the vagina better while inhaling, instead of exhaling – as I tried before. During exhalation the pelvic floor tightens and goes upward while during inhalation the pelvic floor descends and relaxes especially when sitting up (Peper et al, 2016). He advised me to give myself a few minutes with the dilator, and in every inhale – imagine the area opening and insert the dilator a few millimeters. I started practicing again, but in a sitting position, which I found more comfortable and less painful.  I advanced to the biggest dilator within a few weeks, and had a just little pain – sometimes without any pain at all. The most important thing I understood was not to be afraid of the pain. The fear is what made me even more tensed, and tension brings pain. Then, my husband and I started practicing with “the real thing”, very slowly and gently, trying to find the best position and angle for us. Finally, we did it. And it was a great feeling.

The biological factors that affect the relaxation/contraction of the pelvic floor and vaginal opening are:

Feeling safe and hopeful. When threatened, scared, anticipate pain, and worry, our body triggers a defense reaction. In this flexor response, labeled by Thomas Hanna as the Red Light Reflex, the body curls up in defense to protect itself which includes the shoulders to round, the chest to be depressed, the legs pressing together, the pelvic floor to tighten and the head to jut forward (Hanna, 2004). This is the natural response of fear, anxiety, prolonged stress or negative depressive thinking.

Before beginning to work on vaginismus, feel safe.  This means accepting what is, accepting that it is not your fault, and that there are no demands for performance.  It also means not anticipating that it will be again painful because with each anticipation the pelvic floor tends to tightens. Read the chapter  on vaginismus in Dr. Lonnie Barbach’s book, For each other: Sharing sexual intimacy (Barbach, 1983).

Inhale during insertion to relax the pelvic floor and vaginal opening. This instruction is seldom taught because in most instances, we have been taught to exhale while relaxing. Exhaling while relaxing is true for most muscles; however, it is different for the pelvic floor.  When inhalation occurs, the pelvic floor descends and relaxes. During exhalation the pelvic floor tightens and ascends to support breathing and push the diaphragm upward to exhale the air. Be sure to allow the abdomen to expand during inhalation without lifting the chest and allow the abdomen to constrict during exhalation as if inhalation fills the balloon in the abdomen and exhalation deflates the balloon (for detailed instructions see Peper et al, 2016). Do not inhale by lifting and expanding  your chest which often occurs during gasping and and fear.  It tends to tighten and lift the pelvic floor.

Experience the connection between diaphragmatic breathing and pelvic floor movement in the following practice.

While sitting upright make a hissing noise as the air escapes with pressure between your lips. As you are exhaling feel, your abdomen and your anus tightening. During the inhalation let your abdomen expand and feel how your anus descends and pelvic floor relaxes.  With practice this will become easier.

Stretch very, very slowly to avoid triggering the stretch reflex. When a muscle is rapidly stretched, it triggers an automatic stretch reflex which causes the muscle to contract. This innate response occurs to avoid damaging the muscle by over stretching. The stretch reflex is also triggered by pain and puts a brake on the stretching. Always use a lubricant when practicing by yourself or with a partner.  Practice inserting larger and larger diameter dilaters  into the vagina.  Start with a very small diameter and progress to a larger diameter. These can be different diameter cones, your finger, or other objects.  Remember to inhale and feel the pelvic floor descending as you insert the probe or finger. If you feel discomfort/pain, stop pushing, keep breathing, relax your shoulders, relax your hips, legs, and toes  and do not push inward and upward again until the discomfort has faded out.

Feel sexually aroused by allowing enough foreplay. When sexually aroused the tissue is more lubricated and may stretch easier. Continue to use a good lubricant.

Putting it all together.

When you feel safe, practice slow diaphragmatic breathing and be aware of the pelvic floor relaxing and descending during inhalation and contracting and going up during exhalation.  When practicing stretching the opening with cones or your finger, go very, very slow.  Only apply pressure of insertion during the mid-phase of inhalation, then wait during exhalation and then again insert slight more during the next inhalation.  When you experience pain, relax your shoulders, keep breathing for four or five breaths till the pain subsides, then push very little during the next inhalation.  Go much slower and with more tenderness.

Be patient. Explain to your partner that your body and mind need time to adjust to new feelings. However, don’t stop having sex – you can have great sex without penetration. Practice both alone and with your partner;  together find the best angle and rate. Use different lubricants to check out what is best for you. Any little progress is getting you closer to having an enjoyable sex. I recommend watching this TED video of Emily Nagoski explaining the “dual control model” and practicing as she suggests: https://www.youtube.com/watch?v=HILY0wWBlBM

Finally, practice the exercises developed by Dr. Lonnie Barbach, who as one of the first co-directors of clinical training at the University of California San Francisco, Human Sexuality Program, created the women’s pre-orgasmic group treatment program. They are superbly described in her two books, For each other: Sharing sexual intimacy, and For yourself: The fulfillment of female sexuality, and are a must read for anyone desiring to increase sexual fulfillment and joy (Barbach, 2000; 1983). 

References:

Barbach, L. (1983). For each other: Sharing sexual intimacy. New York: Anchor

Barbach, L. (2000). For yourself: The fulfillment of female sexuality. New York: Berkley.

BarLewis, R. W., Fugl‐Meyer, K. S., Bosch, R., Fugl‐Meyer, A. R., Laumann, E. O., Lizza, E., & Martin‐Morales, A. (2004). Epidemiology/risk factors of sexual dysfunction. The journal of sexual medicine1(1), 35-39. http://www.jsm.jsexmed.org/article/S1743-6095(15)30062-X/fulltext

Hanna, T. (2004). Somatics: Reawakening the mind’s control of movement, flexibility, and health. Boston: Da Capo Press.

Martinez Aranda, P. & Peper, E. (2015). The healing of vulvodynia from a client’s perspective. https://biofeedbackhealth.files.wordpress.com/2011/01/a-healing-of-vulvodynia-from-the-client-perspective-2015-06-15.pdf

Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49. https://biofeedbackhealth.files.wordpress.com/2011/01/1-abdominal-semg-feedback-published.pdf

Peper, E., Martinez Aranda, P., & Moss, E. (2015). Vulvodynia treated successfully with breathing biofeedback and integrated stress reduction: A case report. Biofeedback. 43(2), 103-109. https://biofeedbackhealth.files.wordpress.com/2011/01/a-vulvodynia-treated-with-biofeedback-published.pdf

Ter Kuile, M. M., Both, S., & van Lankveld, J. J. (2010). Cognitive behavioral therapy for sexual dysfunctions in women. Psychiatric Clinics of North America33(3), 595-610. https://www.researchgate.net/publication/45090259_Cognitive_Behavioral_Therapy_for_Sexual_Dysfunctions_in_Women

Van Lankveld, J. J., Granot, M., Weijmar Schultz, W., Binik, Y. M., Wesselmann, U., Pukall, C. F., . Achtrari, C. (2010). Women’s sexual pain disorders. The Journal of Sexual Medicine7(1pt2), 615-631. http://www.jsm.jsexmed.org/article/S1743-6095(15)32867-8/fulltext

*We thank Dr. Lonnie Barbach for her helpful feedback and support. Written collaboratively with Tal Cohen, biofeedback therapist (Israel) and Erik Peper.

 

 


Be a tree and share gratitude

 

It was late in the afternoon and I was tired. A knock on my office door.  One of my students came in and started to read to me from a card.  “I want to thank you for all your help in my self-healing project…I didn’t know the improvements were possible for me in a span of 5 weeks…. I thank you so much for encouraging and supporting me…. I have taken back control of myself and continue to make new discoveries about my identity and find my own happiness and fulfillment… Thank you so much.”

I was deeply touched and my eyes started to fill with tears. At that moment, I felt so appreciated. We hugged. My tiredness disappeared and I felt at peace.

In a world where we are constantly bombarded by negative, fearful stories and images, we forget that our response to these stories impacts our health.  When people watch fear eliciting videos, their heart rate increases and their whole body responds with a defense reaction as if they are personally being threatened (Kreibig, Wilhelm, Roth, & Gross, 2007). Afterwards, we may continue to interpret and react to new stimuli as if they are the same as what happened in the video.  For example, while watching a horror movie, we may hold our breath, perspire and feel our heart racing; however, when we leave the theatre and walk down the street by ourselves, we continue to be afraid and react to stimuli as if what happened in video will now happen to us.

When we feel threatened, our body responds to defend itself. It reduces the blood flow to the gastrointestinal tract where digestion is taking place and sends it to large muscles so that we can run and fight.  When threatened, most of our resources shifted to the processes that promote survival while withdrawing it from processes that do not lead to immediate survival such as digestion or regeneration (Sapolsky, 2004).  From an evolutionary perspective, why spent resources to heal yourself, enhance your immune system or digest your food when you will become someone else’s lunch!

The more we feel threatened, the more we will interpret the events around us negatively. We become more stressed, defensive, and pessimistic.  If this response occurs frequently, it contributes to increased morbidity and mortality. We may not be in control of external or personal event; however, we may be able to learn how to change our reactions to these events.  It is our reactions and interpretations of the event that contributes to our ongoing stress responses. The stressor can be labeled as crisis or opportunity.

Mobilize your own healing when you take charge. When 92 students as part of a class at San Francisco State University practiced self-healing skill, most reported significant improvements in their health as shown in Figure 1.

 

figure1

Figure 1.  Average self-reported improvement after practicing self-healing skills for at least four weeks. (Reproduced with permission from Tseng, Abili, Peper, & Harvey, 2016).

A strategy that many students used was to interrupt their cascading automatic negative reactions. The moment they became aware of their negative thought and body slumping, they interrupted the process and practiced a very short relaxation or meditation technique.

Implement what the students have done by taking charge of your stress responses and depressive thoughts by 1) beginning the day with a relaxation technique, Relax Body-Mind, 2) interrupting the automatic response to stressors with a rapid stress reduction technique, Breathe and be a Tree, and 3) increasing vitality by the practice, Share Gratitude (Gorter & Peper, 2011).

Relax Body-Mind to start the day*

  • Lie down or sit and close your eyes. During the practice if your attention wanders, just bring it back to that part of the body you are asked to tighten or let go.
  • Wrinkle your face for ten seconds while continuing to breathe. Let go and relax for ten seconds.
  • Bring your hands to your face with the fingers touching the forehead while continuing to breathe. While exhaling, pull your fingers down your face so that you feel your jaw being pulled down and relaxing. Drop your hands to your lap. Feel the sensations in your face and your fingers for ten seconds.
  • Make a fist with your hands and lift them slightly up from your lap while continuing to breathe. Feel the sensations of tension in your hands, arms and shoulders for ten seconds. Let go and relax by allowing the arms to drop to your lap and relax. Feel the sensations change in your hands, arms and shoulders for ten seconds.
  • Tighten your buttocks and flex your ankles so that the toes are reaching upwards to your knees. Hold for ten seconds while continuing to breathe. Let go and relax for ten seconds.
  • Take a big breath while slightly arching your back away from the bed ore chair and expand your stomach while keeping your arms, neck, buttocks and legs relaxed. Hold the breath for twenty seconds. Exhale and let your back relax while allowing the breathing to continue evenly while sensing your body’s contact with the bed or chair for twenty seconds.  Repeat three times.
  • Gently shake your arms and legs for ten seconds while continuing to breathe. Let go and relax. Feel the tingling sensations in your arms and legs for 20 seconds.
  • Evoke a past positive memory where you felt at peace and nurtured.
  • Stretch and get up. Know you have done the first self-healing step of the day.

*Be gentle to yourself and stop the tightening or breath holding if it feels uncomfortable.

Breathe and be a Tree to dissipate stress and focus on growth

  • Look at a tall tree and realize that you are like a tree that is rooted in the ground and reaching upward to the light. It continues to grow even though it has been buffeted by storms.
  • When you become aware of being stressed, exhale slowly and inhale so that your stomach expands, the while slowly exhaling, look upward to the top of a real or imagined tree, admire the upper branches and leaves that are reaching towards the light and smile.
  • Remember that even though you started to respond to a stressor, the stressor will pass just like storms battering the tree. By breathing and looking upward, accept what happened and know you are growing just like the tree.

Share Gratitude to increase vitality and health (adapted from Professor Martin Seligman’s 2004 TED presentation, The new era of positive psychology).

  • Think of someone who did something for you that impacted your life in a positive direction and whom you never properly thanked. This could be a neighbor, teacher, friend, parent, or other family members.
  • Write a 300-word testimonial describing specifically what the person did and how it positively impacted you and changed the course of your life.
  • Arrange an actual face-to-face meeting with the person. Tell them you would like to see him/her. If they are far away, arrange a Skype call where you can actually see and hear him/her. Do not do it by email or texting.
  • Meet with the person and read the testimonial to her/him.
  • It may seem awkward to read the testimonial, after you have done it, you will feel closer and more deeply connected to the person. Moreover, the person to whom you read the testimonial, will usually feel deeply touched. Both your hearts will open.

point-reyes-trees

References:

Gorter, R. & Peper, E. (2011). Fighting cancer: A nontoxic approach to treatment. Berkeley, CA: North Atlantic Books, 205-207.

Kreibig, S. D., Wilhelm, F. H., Roth, W. T., & Gross, J. J. (2007). Cardiovascular, electrodermal, and respiratory response patterns to fear‐and sadness‐inducing films. Psychophysiology44(5), 787-806.Kreibig, Sylvia D., Frank H. Wilhelm, Walton T. Roth, and James J. Gross. “Cardiovascular, electrodermal, and respiratory response patterns to fear‐and sadness‐inducing films.” Psychophysiology 44, no. 5 (2007): 787-806.

Sapolsky, R. (2004). Why Zebras Don’t Get Ulcers. New York: Owl Books

Seligman, M. (2014). The new era of positive psychology. Ted Talk. Retrieved, December 10, 2016. https://www.ted.com/talks/martin_seligman_on_the_state_of_psychology

Tseng, C., Abili, R., Peper, E., & Harvey, R. (2016). Reducing Acne-Stress and an integrated self-healing approach. Appl Psychophysiol Biofeedback, 4(4), 445.)

 

 


Relax and Relax More*

After raising my shoulders and then relaxing it, I felt relaxed. I was totally surprised that the actual muscle tension recorded with surface electromyographic (SEMG)  still showed tension. Only when I gave myself the second instruction, relax even more, that my SEMG activity decreased.

In our experiences, we (Vietta E. Wilson and Erik Peper, 2014)  have observed that muscle tension often does not decrease completely after a person is instructed to relax. The complete relaxation only occurs after the second instruction, relax more, let go, drop, or feel the heaviness of gravity. The person is totally unaware that after the first relaxation their muscless  have not totally relaxed. Their physiology does not match their perception (Peper et, 2010; Whatmore & Kohli, 1974). The low level of muscle tension appears more prevalent in people who are have a history of muscle stiffness or pain, or in athletes whose coaches report they look ‘tight.’ It is only after the second command, relax and release even more, that the individual notices a change and experiences a deeper relaxation.

The usefulness of giving a second instruction, relax more, after the first instruction, relax, is illustrated below by the surface electromyographic (SEMG) recording from the upper left and right trapezius muscle of a 68 year old male with chronic back pain. While sitting upright without experiencing any pain, he was instructed to lift his shoulders, briefly hold the tension, and then relax (Sella, 1997; Peper et al, 2008). When the SEMG of the trapezius muscles did not decrease to the relaxed state, he was asked to relax more as is shown in Figure 1.

Figure 1 Muscle tension

Figure 1. SEMG recordings of the left and right upper trapezius when the client was asked to lift his shoulders, hold, relax, and relax more. Only after the second instruction did the muscle tension decrease to the relaxed baseline level. Reprinted from Wilson and Peper, 2014.

Although the subject felt that he was relaxed after the first relaxation instruction, he continued to hold a low level of muscle tension. We have observed this same process in hundreds of clients and students while teaching SEMG guided relaxation and progressive muscle relaxation.

For numerous people, even the second commands to relax even more is not sufficient for the SEMG to show muscle relaxation and for them to ‘feel’ or know when they are totally relaxed. These individuals may benefit from SEMG biofeedback to identify and quantify the degree of muscle tension. With this information the person can make the invisible muscle contractions ‘ visible,’ the un-felt tension ‘felt,’ and thus develop awareness and control (Peper et al, 2014).

In summary

  1. Instruct people to relax after tightening and then repeat the instruction to relax even more.
  2. Use surface electromyography to confirm whether the person’s subjective experience of being muscularly relaxed corresponds to the actual physiological SEMG recording.
  3. Use the SEMG biofeedback to train the person to increase awareness and learn relaxation (Peper et al, 2014).
  4. Read the complete article from which this blog was adapted: Wilson, E. & Peper, E. (2014). Clinical Tip: Relax and Relax More. 42(4), 163-164.

References

Peper, E., Booiman, A., Lin, I-M., & Shaffer, F. (2014). Making the Unaware Aware-Surface electromyography to unmask tension and teach awareness. Biofeedback. 42(1), 16-23.

Peper, E., Booiman, A., Tallard, M., & Takebayashi, N. (2010). Surface electromyographic biofeedback to optimize performance in daily life: Improving physical fitness and health at the worksite. Japanese Journal of Biofeedback Research, 37(1), 19-28.

Peper, E., Tylova, H., Gibney, K.H., Harvey, R., & Combatalade, D. (2008). Biofeedback mastery-An experiential teaching and self-training manual. Wheat Ridge, CO: AAPB.

 

*This blogpost is adapted from, Wilson, E. & Peper, E. (2014). Clinical tip: Relax and relax more. Biofeedback. 42(4), 163-164.

 


A breath of fresh air-Improve health with breathing

“My breathing was something that took me a long time to adjust. I had been breathing almost entirely from my chest and my stomach was hardly moving when I breathed. I made a conscious effort all throughout the day to breathe slowly and with my stomach relaxed. I’ve noticed that my mood is much better when I am breathing this way, and I am much more relaxed. Immediately before I feel like I would have a seizure, if I would change my breathing technique and make sure I was breathing slowly and with my stomach. It would avoid the seizure from developing… This is a huge improvement for me.”  –24 year old student who previously experienced 10 epileptic seizures per week

“I blanked out and could not remember the test material. I then reminded myself to breathe lower and slower while imagining the air slowly flowing down my legs. After three breaths, I could again process the information and continue to take the exam. A week later I got my grade back– an A-. Better than I had expected.”  –21 year old student

Breathing occurs without awareness unless there are specific problems such as asthma, emphysema or when we run out of air while exercising. Breathing is more than just the air moving in and out. It is the boundary between the conscious and the unconscious—the voluntary and involuntary nervous system— and affects the sympathetic and parasympathetic activity of our body. The way we breathe,  such as chronic low level hyperventilation,  may contribute to increasing or decreasing anxiety, pain, epileptic seizure, exhaustion, abdominal pain, urinary incontinence or fertility.

We usually think of breathing occurring in our chest. Thus, during inhalation, we puff-up our chest so the lungs will expand. Observe that many people breathe this way and call it normal. Experience how you breathe:

Put your right and on your stomach and your left hand of your chest. Now take a quick big breath. Observe what happened. In most cases, your chest went up and your abdomen tightened and even pulled in.

This breathing pattern evokes a state of arousal and vigilance and activates your sympathetic nervous system. You tend to automatically tighten or pull in your stomach wall to protect your body. When we’re in pain, afraid, anticipate danger or have negative and fearful thoughts, “Do I have enough money for the rent,” or “Feeling rushed and waiting for a delayed Muni bus,” we instinctively hold our breath, slightly tense our muscles and breathe shallowly. Unfortunately, this makes the situation worse—symptoms such as pain, anxiety or abdominal discomfort will increase. This type of breathing is the part of the freeze response—a primal survival reflex. It may even affect our ability to think.  Experience how dysfunctional breathing effects us by doing the following exercise (Peper & MacHose, 1993; Gorter & Peper, 2011).

Sit comfortably and breathe normally.

Now inhale normally, but exhale only 70 percent of the air you just inhaled.

Inhale again, and again only exhale 70 percent of the previously inhaled volume of air. If you need to sigh, just do it, and then return to this breathing pattern again by exhaling only 70 percent of the inhaled volume of air.

Continue to breathe in this pattern of 70 percent exhalation for about forty-five seconds, each time exhaling only 70 percent of the air you breathe in. Then stop, and observe what happened.

What did you notice? Within forty-five seconds, more than 98 percent of people report uncomfortable sensations such as lightheadedness, dizziness, anxiety or panic, tension in their neck, back, shoulders, or face, nervousness, an increased heart rate or palpitations, agitation or jitteriness, feeling flushed, tingling, breathlessness, chest pressure, gasping for air, or even a sensation of starving for air. This exercise may also aggravate symptoms that already exist, such as headaches, joint pain, or pain from an injury. If you’re feeling exhausted or stressed, the effects seem even worse.

On the other hand, if you breathed like a happy baby, or more like a peaceful dog lying on its side, the breathing movement occured mainly in the abdomen and the chest stays relaxed. This effortless diaphragmatic breathing promotes regeneration by allowing the abdomen to expand during inhalation and becoming smaller during exhalation as shown in Figure 1.

Figure 1

Figure 1. Illustration of diaphragmatic breathing in which the abdomen expands during inhalation and contracts during exhalation (reproduced by permission from Gorter, R. & Peper, E. (2011). Fighting Cancer-A Non Toxic Approach to Treatment. Berkeley: North Atlantic).

The abdominal movement created by the breathing improves blood and lymph circulation in the abdomen and normalizes gastrointestinal function and enhances regeneration. It supports sympathetic and parasympathetic balance especially when the breathing rate slows to about six breaths per minute. When breathing slower, exhaling takes about twice as long as the inhalation. When you inhale, the abdomen and lower ribs expand to allow the air to flow in and during exhalation the abdomen decreases in diameter and the breath slowly trails off. It is as if there is an upside down umbrella above the pelvic floor opening during inhalation and closing during exhalation.

Most people do not breathe this way . They suffer from “designer’s jean syndrome”. The clothing is too constricting to allow the abdomen to expand during inhalation (Remember how good it felt when you loosened your belt when eating a big meal?). Or, you are self-conscious of your stomach, “What would people thinks if my stomach hung out?” Yet, to regenerate, allow yourself to breathe like peaceful baby with the breathing movements occurring in the belly.  Effortless diaphragmatic breathing is the cheapest way to improve your health. Thus observe yourself and transform your breathing patterns.

Interrupt breath holding and continue to breathe to enhance health. Observe situations where you hold your breath and then continue to breathe. If you expect pain during movement or a procedure, remember to allow your abdomen to expand during inhalation and then begin to exhaling whispering “Shhhhhhhhh.” Start exhaling and then begin your movement while continuing to exhale. In almost all cases the movement is less painful and easier. We observed this identical breathing pattern in our studies of Mr. Kawakami, a yogi who insert unsterilized skewers through his neck and tongue while exhaling—he did not experience any pain or bleeding as shown in Fig 2.

Figure 2

Figure 2. Demonstration by Mr. Kawakami, a yogi, who inserted non-sterile skewers while exhaling and reported no pain. When he removed the skewers there was no bleeding and the tissue healed rapidly (by permission from Peper, E., Kawakami, M., Sata, M. & Wilson, V.S. (2005). The physiological correlates of body piercing by a yoga master: Control of pain and bleeding. Subtle Energies & Energy Medicine Journal. 14(3), 223-237).

Shift shallow chest breathing to slower diaphragmatic breathing. Each time you catch yourself breathing higher in your chest. Stop. Focus on allowing your abdomen to expand during inhalation and become smaller during exhalation as if it was a balloon. Allow the air to flow smoothly during exhalation and allow the exhalation to be twice as long as the inhalation. Over time allow yourself to inhale to the count of three and exhale to the count of 6 or 7 without effort. Imagine that when you exhale the air flows down and through your legs and out your feet. As you continue to breathe this way, your heart rate will slightly increase during inhalation and decrease during exhalation which is an indication of sympathetic and parasympathetic restorative balance. A state that supports regeneration (for more information see, Peper, E. & Vicci Tibbetts, Effortless diaphragmatic breathing).

For many people when they practice these simple breathing skills during the day their blood pressure, anxiety and even pain decreases. While for other, it allows clarity of thought.

 

 

 

 


Making the Unaware Aware*

“You only have to think to lift the hand and the muscles react.”

“I did not realize that muscle tension occurred without visible movement.”

“I was shocked that I was unaware of my muscle activity—The EMG went up before I felt anything.”

“Just anticipating the thought of the lifting of my hand increased the EMG numbers.”

“After training I could feel the muscle tension and it was one third lower than before I started.”

                                                            -Workshop participants after working with SEMG feedback

Many people are totally unaware that they are tightening their muscles and continuously holding slight tension until they experience stiffness or pain. This covert low-level muscle tension can occur in any muscle and has been labeled dysponesis, namely, misplaced and misdirected efforts (from the Greek: dys = bad; ponos = effort, work, or energy) (Whatmore & Kohli, 1974; Harvey & Peper, 2012). This chronic covert tension is a significant contributor to numerous disorders that range from neck, shoulder, and back pain to headaches and exhaustion and can easily be observed in people working at the computer.

While mousing and during data entry, most people are unaware that they are slightly tightening their shoulder muscles. One can often see this low level chronic tension when a person continuously lifts an index finger in anticipation of clicking the mouse or bends the wrist and lifts the fingers away from the keyboard while mousing with the other hand as shown in Figure 1.

Fig 1 hand lift

Figure 1. Lifting the hand without any awareness while mousing with the other hand (from Peper et al, 2014)

People may hold a position for a long time without being aware that they are contracting their muscles. They are focusing on their task performance. They are “captured by the screen” – until discomfort and pain occur. Only after they experience discomfort or pain, do they change position. Factors that contribute to this apparent lack of somatic awareness include:

  • Being captured by the task. People are so focused upon performing a task that they are unaware of their dysfunctional body position, which eventually will cause discomfort.
  • Institutionalized powerlessness. People accept the external environment as unchangeable. They cannot conceive new options and do not attempt to adjust the environment to fit it to themselves.
  • Lack of somatic awareness and training. People are unaware of their own low levels of somatic and muscle tension.

 Being Captured By the Task

People often want to perform a task well and they focus their attention upon correctly performing the task. They forget to check whether their body position is optimized for the task. Only after the body position becomes uncomfortable and interferes with task performance, do they become aware. At this point, the discomfort has often transformed into pain or illness.

This process of immediately focusing on task performance is easily observed when people are assigned to perform a new task. For example, you can ask people who are sitting in chairs arranged by row to form discussion groups to share information with the individuals in front or behind them. Some will physically lift and rotate their chair to be comfortable, while others will rotate their body without awareness that this twisted position increases physical discomfort. As instructors, we often photograph the participants as they are performing their tasks as shown in Figure 2.

Fig 2a sitting on chairs
Figure 2. Workshop participants rotating their bodies or chairs to perform the group exercise (from Peper et al, 2014).

Although there are many strategies to teach participants awareness of covert tension, our recent published article, Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness,describes a simple biofeedback approach to teach awareness and control of residual muscle contraction. Almost all the subjects can rapidly learn to increase their recognition of minimal muscle tension as shown in figure 3.

Fig 5 EMG graphFigure 3. Measurement of forearm extensor muscle awareness of minimum muscle tension before and after feedback training (from Peper et al, 2014).

This study showed that participants were initially unaware of covert tension and that they could quickly learn to increase their sensitivity of muscle tension and reduce this tension within a short time period. Surface electromyograpy (SEMG) provides an objective (third person) perspective of what is actually occurring inside the body and is more accurate than a person’s own perception (first person perspective). The SEMG feedback (numbers and graphs) learning experience was a powerful tool to shift participants’ illness beliefs and encourage them to actively participate in their own self-improvement. It demonstrated that: 1) they were unaware of low tension levels, and 2) they could learn to increase their awareness with SEMG feedback.

The participants became aware that covert tension could contribute to their discomfort and would inhibit regeneration. In some cases, they observed that merely anticipating the task caused an increase in muscle tension. Finally, they realized that if they could be aware during the day of the covert tension, they could identify the situation that triggered the response and also lower the muscle tension.

For detailed methodology and clinical application, see the published article, Peper,E., Booiman, A., Lin, I-M., & Shaffer, F. (2014). Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness. Biofeedback, 42(1), 16-23.

References:

Harvey, E. & Peper, E. (2012). I thought I was relaxed: The use of SEMG biofeedback for training awareness and control. In W. A. Edmonds, & G. Tenenbaum (Eds.),Case studiesin applied psychophysiology: Neurofeedback and biofeedback treatments foradvances inhuman performance. West Sussex, UK: Wiley-Blackwell, 144-159.

Whatmore, G. B., & Kohli, D. R. (1974). The Physiopathology and Treatment of Functional Disorders: Including Anxiety States and Depression and the Role of Biofeedback Training. Grune & Stratton.

*Adapted from: Peper,E., Booiman, A., Lin, I-M., & Shaffer, F. (2014).Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness. Biofeedback.42(1), 16-23.


Focus On Possibilities, Not On Limitations. Youtube interviews of Erik Peper, PhD, by Larry Berkelhammer, PhD

Focus On Possibilities, Not On Limitations

This interview with psychophysiologist Dr. Erik Peper reveals self-healing secrets used by yogis for thousands of years. Mind-training methods used by yogis like Jack Schwarz were explored. The underlying message throughout the discussion was that suffering and even actual tissue damage are profoundly influenced by both our negative and our positive attributions. The methods by which yogis have learned to self-heal is available to all of us who are willing to assiduously adopt a daily practice. It is very clear that when our attention goes to our pain or other symptoms, our suffering and even tissue damage worsens. When we focus all our attention on what we want rather than on what we are afraid of, we achieve a healthier, more positive, and more robust level of healing. We suffer when we have negative expectancies and we reduce suffering when we focus our attention on positive expectancies. We can train the mind to fully experience sensations without negative attributions. For the vast majority of us, we have far greater potential than we believe we have. Biofeedback, concentration practices, mindfulness practices, and other yogic practices allow us to condition ourselves to concentrate on the present moment, rather than on our negative expectancies, limitations, attributions, and fears.

Belief Becomes Biology

Dr. Larry Berkelhammer speaks with Dr. Erik Peper about the connection of our beliefs and our health.