I mean this in the most physiological and anatomical sense.

What’s interesting and most relevant to me is our tendency to keep trying the same thing again and again, even though it’s clearly not working very well. I’d noticed this in working with my own aches, pains and less-than-efficient ways of being. (And as a side note, isn’t that tendency the definition of insanity? a bit dramatic perhaps, but worth noting.)

As an example: my left shoulder used to feel tight and creaky nearly all the time—I’m still prone to it for sure, but it happens much, much less now.

Old-school me, stretching what hurt.

What I’d done for years was stretch the achey shoulder out and away from my neck. I would spend so much time stretching and stretching, and even after many months of this, didn’t actually feel any better in my shoulder. Yet, for what it’s worth, I was sure I just needed to keep doing this, what I was doing, keep stretching those achey myofascial fibers.

Skip forward a few years. What has been part of a dramatic change for the better in this shoulder, along with structural integration and a smarter approach to climbing, was this new inquiry*: if the evidence is pointing to the fact that something isn’t working, try something different, try the opposite thing to start.

Playing with a newer, and more effective, idea of trying literally the opposite of what I always (used to) do in search for pain relief, both temporary and permanent.

Just try it. For me, this looked like actually starting to play with shrugging the shoulder up (to slack the neuromyofascial tension, particularly along the nerves, I would later come to identify), and ultimately a very light but very effective strength training program employing alignment and tension in the deepest recesses of my shoulders and thoracic spine.***

The moral here isn’t that you should always shrug up for shoulder pain—sometimes the opposite, I’m sure, or sometimes movement might not be helpful at all—but it’s a free, simple, DIY remedy to at least give a go.

The remedy, again, is this: Don’t do what you “always do.” Interrupt the pattern. Try something different.

And if you’re interested, this is about as good as mind-body metaphors get

Let me know how it goes! Cheers, Liam

*Much thanks to my former SI instructor, current mentor of sorts and amazing practitioner, Lauren Christman, for this post. It was really in her office that I got this for the first time.

***I’d be happy to chat in more depth about my own process with this particular technique/approach to my particular shoulder stuff. I’m sparing the details here for brevity’s, and thus clarity’s, sake.

This train of thought began awhile ago, when I finally conceded that willpower is not one of my strengths.

At some point in my twenties, it had dawned on me not only that willpower is not a strength of mine, but that it’s the one tool for personal change I had relied on relentlessly. When I failed, and I often did, I tried to muster up more of it.

I began to feel like I was paddling a canoe with a hammer. When I would start drifting off course, I’d paddle the hammer harder. Sure it’s a great tool, but not the tool for this job.

Before going any further, let’s be clear I’m talking about good old fashioned, day-to-day kinds of change. For the sake of this blog, let’s take classic things like engaging in positive movement (“exercise” if you want to call it that; I don’t), eating well, drinking enough water throughout the day, getting on a sane sleep schedule. Stuff like that.

In my search for understanding, I think I’m onto two things. I’m sure neither of them are new per se—I’ve actually probably read them both on Yogi Tea bags at some point—but they do feel real and poignant now.

I’ve noticed:

1.  a tendency for either direction—donuts or broccoli—to gain some significant momentum without much effort after certain initial choices. One of my earliest memories of this was noticing that after yoga classes in college, I actually wanted to eat a salad much more than a fast-food burger.

For me, yoga was what I’m now calling a high-leverage activity. I’ve since identified a few in my own life, now defined as much by feel as by specific act … or, rather, the specific acts will tend to change.

On the other end, choosing food is not a high-leverage activity for me, as in it tends to be much more an effect than a cause. To date, food choices are where I will nearly always notice my willpower failing without something more high-leverage in charge of my trajectory.

And speaking of trajectory …

2. an interesting question emerging: who’s battling who here? This gets existential pretty fast, tho’ also serves as a useful platform, I think, whenever we’re looking at questions of what we want. As in, there’s only one of me … what do I wholly want, feel to be true, etc?

I add this second realization mostly because I really appreciate where the two meet: for me, and I’d venture to say for a lot of us, engaging in those high-leverage activities also tends to engage us in ways that offer us the most opportunity to grow.

For example, I could have grit my teeth and eat a salad instead of what I really wanted, but rarely did, until in this case the yoga classes were a pretty powerful psychosomatic, or mind-body, opening experience for me. (I’m only noticing this in retrospect.) The high-leverage activity set a certain trajectory and a momentum followed from there.

Willpower isn’t nearly as important for me as I used to think, though it certainly can’t be zero, as something’s got to get us off the ground.

Thus, an equation for positive change: change = (leverage x [willpower/100]) + (trajectory x # of days since leverage implemented)

∆ = LW/100 + TD

Simple, right? Joking aside, these realizations have been helpful for me, and I’d hope the same, as always, for you!

I’d also be curious to hear how you actually create positive change in your life, how you’ve failed at it, or both! Comment below if you’d be willing to share with the public, or send me an email.

Thanks, cheers, Liam

What I found out really changed the way I think about ibuprofen. Below is a summary of what I found out. If you’d like, here’s a link to the full paper; it’s moderately, though not overly, technical.

A few notes about NSAIDs to start: they are a hugely popular drug—I would be very surprised if anyone reading this paper had never taken an aspirin or ibuprofen—and for good reason. They’re effective at reducing pain and inflammation, and thus improving mobility and, say, being able to sleep. They’re inexpensive and easily attainable without a prescription.

That’s all the upside.

Here’s the downside: it seems NSAIDs interfere with the production of healthy connective tissue. This may not initially seem like a big deal, but when you consider that literally every muscle, every muscle cell, every organ and nerve and bone and artery … that all of that is wrapped in layers of connective tissue, that it is literally a structural part of every system in our body … then the issue may start to seem a little bigger. It did for me.

Even on a gross anatomical level, there have been numerous studies** concluding that NSAID use post-injury, or post-surgery, actually inhibits tendon-to-bone repair. As in, if you tore your rotator cuff, there are quite a few studies suggesting that regularly taking ibuprofen actually makes your shoulder weaker by the time it’s recovered.

This, of course, is the exact opposite of a lot of conventional thinking, of the way I thought about it for most of my life.

The conventional, and pretty logical, idea is that inflammation is often a sort overreactive protection mechanism your body does to guard, say, a sprained ankle. It swells way up, and hurts, so you don’t use it. This swelling up—inflammation—doesn’t allow for very good fluid exchange, which is indeed an important part of healing: getting the toxins out and fresh stuff in. An anti-inflammatory can decrease this swelling and thus increase fluid exchange in the injured tissue.

It turns out, though, that some of the big players in breaking down tissue, notably a class of hormone-like compounds called prostaglandins, are also big players in building up tissue. These prostaglandins actually do a myriad of important activities (some of which have to do with the gut; you may have heard of intestinal problems stemming from too much NSAID use; it’s the only side effect I’d ever heard of before writing this paper).

Thus, when we take NSAIDs that act systemically in inhibiting the production and release of prostaglandins, we’re actually tinkering with a much bigger part of our physiology than the sprained ankle.

Of course, the effects of the sprained ankle becoming less inflamed are rather immediate, and the potentially weakened local ligament structure and diminished prostaglandin production in rest of the body happen over a longer arc of time, and thus tend to be harder for us to track. That’s one of the big benefits of these scientific studies: some people did track what happens, and the results of most of what I read suggest that regular NSAID use does more harm than good in this long-term, and even medium-term, scope of time.

So, what to do with all this information?

Here’s one scenario: you’re out hiking in the woods, and you roll your ankle and have to walk out. By all means, if I were you, I’d take a big dose of ibuprofen to reduce pain, increase mobility and decrease the damage that I’d be doing by walking on an injured joint.

Other scenarios, like being sore after a workout, or sustaining an injury that you can afford to not move around on for awhile, or a host of other conditions that may warrant daily NSAID use (the following with the huge disclaimer of consulting your doctor and your common sense both, all that) … Can you let it rest, and just deal with, dare we say invite, the inflammatory process?

For more immediate relief: local, manual ways of helping move wastes out and fresh fluids in can be really helpful with no particular downsides. These would include massage (especially for post-workout kind of soreness, and later on, but not immediately after, for traumatic injury), and ice or cold/warm hydrotherapy.

It’s ill-advised to take NSAIDs prophylactically, i.e. before a workout you anticipate you might get sore during. There are studies suggesting that with this practice you would be more likely to, for example, rupture a tendon pulley while rock climbing, or pull a hamstring while running.

I’ll emphasize here that most of the studies I read were examining relatively long-term use and its consequences. This is not a doomsday blog post saying that you should never take NSAIDs. If I had to choose between falling asleep and taking 400 mg of ibuprofen, I’d probably choose the latter almost every time.

However, if I had to take that dose to fall asleep, or get through the day without pain, day after day … I’d be on the keen lookout for alternatives.

*this paper was recently published in the 2012 Yearbook for the International Association of Structural Integrators. If you’d like a copy, they’re $55 and you can use this order form.

**I’m not going to footnote any studies here. They’re all in the endnotes of the paper.

Some of the most vulnerable moments for me in my practice are at the very start of a bodyreading session (and you thought you were vulnerable, standing there in your underwear!), or when my client stands up for reassessment after doing some work on the table.

Those are the moments when the best I can do, literally, is begin with a blank slate, and simply see what’s there. It feels vulnerable because I honestly don’t know what I’m going to see, and therefore what I’m going to do from there. I have to wait.

As I get better and better at what I do, I also notice there’s less and less I can consistently say about any given pattern or condition. I feel much less certain now than I ever have before that a poor breathing pattern is caused by internally rotated shoulders, or that the root of low back pain tends to lie in the psoas.

It can seem a little crazy to hear your healthcare provider say this, but … I quite often have no idea.

Until I do. Until we’re both standing there, getting a sense of what’s actually going on with only the most barebones of preconceived notions to guide us.

It seems like there’s something in the middle — between emphatically certain allopathic causal medicine, and hopelessly vague assessments relying on intuition with no left-brain activity. There’s a way that doesn’t use “I don’t know” as a crutch, but rather as a real launching pad for a unique path to integration and health to unfold … as one of the clearest lenses out there from which to gaze through …

In fact, some of the most difficult moments I have with clients are when someone comes in having everything figured out: the problem, the pattern, the way it is and will be. The difficulty isn’t that they’re necessarily wrong per se, but that the rigidity of diagnosis doesn’t allow for much movement, or potential for unexpected change.

We change. Patterns can change. Thank goodness.

Now, the challenging part, is to see what’s really going on …

As its worst, I think, this kind of questioning is a way of avoiding, of mentally needing every duck in a row before committing to something (and there are always ducks not in their rows, yeah?). As its best, though, it’s an appreciation of the whole, of beginnings and endings mirroring each other, and existing co-dependently.

That’s my long introduction for what’s below: a one-page letter I just wrote to give to my first, and subsequent, graduates of a KMI Structural Integration series. So even though it’s not a letter to you per se, if you haven’t gone through a full SI series, it’s for you if it offers any more insight into this process.

Thoughts for Departure

“Tell me, what is it you plan to do

With your one wild and precious life?”

—Mary Oliver

Cheers on completing your Structural Integration series! Perhaps take a moment to reflect upon the you who walked in my door months ago, and the you who is reading these words now.

Like any good graduation, this is of course an ending, though just as certainly a beginning, and in many ways now is when the real change begins. By that I mean, the task now is to live into your new structure and its new pattern, expansional ability, limitations and all.

Here are a few guidelines I’ve found helpful in this process.

• Listen for what’s next.

You may find your patterns in daily life have naturally shifted, either subtly or dramatically. In terms of movement, this may look like you not feeling as drawn to an old sport or way of moving as you once were, maybe as you “have always been.” Tune into your internal listening for what’s next, how your structure wants to move and express now. Don’t worry, it’s not permanent; it never is.

As a rule of thumb: movement in general, and especially more multi-planar movement, will help reinforce and develop an expanded posture. Think yoga, dance, tai chi (though the same principles can certainly be found in more typically-linear sports like running, or lifting weights). Again, start by noticing what you’re feeling drawn to now.

• Reinforce positive change.

As with anything in the body, good nutrition, hydration and enough rest will continue to serve you well. Especially now.

• Rest assured.

Changes in the fascial web would last for months untouched. And, of course, they’re not untouched. The openness is reinforced every time you stretch your arms above your head in the morning, or walk in a more balanced, expanded way.

• More bodywork …

… may indeed be in your future. As a rule of thumb for more structural bodywork, live into what you’ve got now for six months to a year or so. After that time, you could come back for a shorter, probably three-to-five session, “tune up” of sorts (I put this in quotes because in some ways it’s a tune up, and in some ways it’s actually working with deeper structures that weren’t available to us originally).

As for if and when, this goes back to listening for what’s next. You’ll know.

May all this allow you to serve the world well.

In partnership,

Liam Bowler, LMP, BCSI

Dynamic Alignment Bodywork

2. We change. We sometimes tend to think of this mostly as a negative thing, no? Like oh, I’m getting old so I’m changing for the worse. Or that we’re basically the same, only just skinnier or fatter, stronger or weaker, than we used to be. All that can be true, and … the very foundational shape of who you are is subject to change. In fact, that’s what structural integration is all about. I’ve experienced this change now quite remarkably in my own structure, and with a growing number of clients.

3. I love being up in front of crowds. I taught and co-taught with Brian Crosier, PT, two really awesome Functional Anatomy clinics. Here’s one poster. Two more coming up this spring: one for skiers on January 18th and another for climbers in March. Check back for details, or contact me to be put onto the DAB mailing list.

4. The body and the mind tend to be expressions of one another. I can’t help but to have seen this to be true. I don’t think this implies we should try to force positive thoughts into our heads, or wear dippy smiles all day and pretend to be unaffected by our lives. I do think this means that work on the body tends to affect the psyche, and vice versa.

5. Posture and movement are likewise interrelated. As in, if we’re thinking of good posture as something static to achieve and hang onto, we’re largely missing the boat. That said, if you feel like your stride is a little off, you may be in good company here.

6. Research shows lots to be wary of with the use of NSAIDs, like ibuprofen. This is the topic of my next post after this, so stay tuned, but the short for now is: if you can not take them it’s probably best not to, especially prophylactically (i.e., before an event that you think you will likely make you really sore) or long-term.

7. Our world is rapidly changing. Need we any more evidence than to look around? Here’s to our good fortune thus far, even and especially in its most disguised of forms.

Happy New Year, y’all. Peace, Liam

Get out a pen to jot down your answer. Got one? Great. Now please, stand up, arms relaxed at your sides. From here, lift one of your arms straight out to the front, palm down, up 90 degrees (that’s straight out from your shoulder).

The pop quiz question: what was the first muscle to engage in that movement? You don’t need to know technical anatomical language for your answer to count, as in, you could say “the front of the neck.” And I’ll give you a hint: it’s not the brain, but an actual, tangible, everyday muscle (even though yes, it’s a conscious movement so there’s neural activity).

Probably some muscle in the front of the shoulder, right? That was my guess when I took this quiz. Or, if you were super savvy and had a sense of where this was headed, maybe you answered some part of your abdominal core, like the deep transversus abdominis.

The answer: the soleus, one of the deep muscles in your calf that connects to your Achilles tendon.

The reason: to begin the process of lifting your arm out front, and thus moving your center of weight more forward, your unimaginably intelligent body begins with an ever-so-slight movement of plantar flexion, or the ball of your foot pressing into the earth (or, if you’re driving a car, on the gas pedal).

Another visual that might help if you’re still feeling confused: recognize that the plantar flexion, if left unchecked, would push everything above your feet backwards. And that’s where your arm moving forward comes in as a sort of balance, so only your arm actually moves.

Can you feel it happening? (I can’t, but kudos if you can!)

Amazing, no? Imagine the implications. It seems so obvious to think raising an arm happens at the joint right next to the arm, which is does, but that’s not the whole story, or even the first part of the story.

Now, pass your papers to the front of the class …

You are a marriage counselor. Deb and Brian come to your clinic, seeking help for their recently troubled relationship.

Sure, you say, tell me your story. Well, they say, they’ve been happily together for almost ten years. Then, in a conversation to decide where to celebrate their tenth anniversary, Brian said some passive comment about how Deb always wants to go to the beach and just sit around. Deb got defensive, and said something about how Brian can’t just relax sometimes. This escalated into a full-blown shouting match, and several have followed since.

What do you, as the therapist, focus on? Probably not the “anniversary vacation” conversation itself, right? We’d be foolhardy to think Deb and Brian’s relationship troubles started with that conversation, or that they’ll go away if we created rules that they can never talk about tenth anniversaries, or maybe anniversaries in general if we wanted to be a little more holistic about it.

As in: the problem isn’t the content, or the proverbial straw that broke the camel’s back. The problem, in this case, is something underlying that might show up as an argument about a vacation, or just as easily as one of infinite issues couples can argue about. It probably won’t resolve until we get more fundamental … unless you as a counselor want to keep putting out small fires, which is a great way to stay employed.

You probably see where I’m going with this.

Is it so different to see the internal relationships of the body in a similar light? A system under physiological stress can adapt and cope and deal … until it can’t, not as well at least.

Interestingly, though understandably I suppose, seeing our health in this way is not really the norm in medicine. There is a certain logic that this one thing is the problem so it’s this one thing that needs to be fixed, because it’s only this one thing that hurts and is grabbing all of our attention.

It’s a classic and oft-told story: “I bent over to pick up whatever, when wham, my back went out.” So we go into someone to work on the back, concluding that we must’ve just really picked up that box in a weird way (which may well be true). We mend the damage done, analogously, by the anniversary vacation argument.

But what then?

Please don’t take this to suggest we should all be paranoid that imbalances in the body will eventually lead to pain and disease (an interesting article on this here), or that finding the deeper source of pain is hopelessly holistic and therefore vague and untrackable. That’s not particularly helpful, either.

This is an invitation to look at your own experience with your own health.

Is it really that crazy to say neck pain is a whole-system issue? Or that the causes of plantar fasciitis, or carpal tunnel syndrome, are not isolated to the tissues displaying the symptoms?

Are you interested in putting out small fires, or in finding out what’s with everything being so combustible?

Fair question.

I get asked this a decent amount (as you might imagine), and often can’t answer in anything less than a ten-minute-long tirade about structure and function and the grand interconnectedness of the cosmos.

Thankfully for anyone seeking a shorter answer, I have been working on this one liner for awhile now: KMI Structural Integration is a powerful and system-oriented method of balancing the body, improving mobility and freeing stagnant, chronic pain. It is deep, lasting, significant bodywork.

Another, even simpler, description of what it’s all about could be making peace with gravity.

Let’s start with logistics: a Structural Integration series consists of 12 sessions, sometimes a bit more (in KMI, which is my particular school of SI; Rolfing® is an example of another). The work addresses freeing and balancing the whole of the body in an intelligent, progressive and holistic way. The vehicle for this change is the myofascia. That’s a clinical, though most accurate, term for your soft tissues, so including your muscles, your tendons and ligaments, and the ubiquitous net of fascia surrounding and investing your musculature, your guts, your nerves … everything, quite literally.

Also a big part of a series is a re-education of the body’s movement patterns. These patterns can deeply sustain our energy (think the eternal poise and alignment of the dancing Fred Astaire), or rob us of it (think the head-forward, shoulders-rolled-forward position of someone who’s spent way too much time in a cubicle).

It’s hands-on and movement-oriented, meaning my hands are helping to open, balance and re-integrate your tissue—you!—and your movement is a big part of that.

Goals of an SI series will vary from person to person (patients and practitioners alike), though a few overarching themes, and in general the things that KMI Structural Integration is exceptionally good at:

• Freedom from pain, especially chronic, stagnant pain (as opposed to the kind where you just sprained your ankle or something and it hurts now; this work would more address both the possible predisposition to and the implications following that sprain).
• More optimal ranges of motion, for couch potatoes and athletes alike.
• A better internal kinesthetic map, your felt sense of where you are, quite literally. This one is huge in its implications.
• Ability to discharge “stuck” thoughts and emotions, also called somato-emotional release. For some people, this part of their series is very profound; for others, less so.
• Increased vitality and adaptability in engaging with the gazillions of potential stressors that will continue to occur in your life, unless you’re planning on sitting in a cave for the rest of it (and even then …).

There are four noteworthy stages in a full 12-session series.

1. Sessions one through four address opening the “sleeve” myofasciae (more superficial).
2. Sessions four through eight address opening and balancing the “core” myofasciae (deeper, both anatomically and, in my experience, energetically).
3. Sessions eight through 12 are the integration sessions of core and sleeve. These sessions fine-tune your daily movement, and the ability of your whole structure to move, and simply be, in concert.
4. After session 12 … that’s it for your work with me, at least for a year or so when you may wish to come back for a tune up. Your integration will very much continue for months and even years after you’ve left my office. The closed-ended nature of this therapy is an important piece of this work and, as far as I know, unique to SI as a field.

It’s worth noting, I think, that while the above is a tidy summary of what happens over a series, generally speaking, it is of course not a conclusive summary. As in: your KMI Structural Integration series will very much unfold for you in a way that’s unique for you, your structure, your history, your goals … your life!

That’s what happens, to the best of my ability to articulate it. More detail here on KMI’s website if you’re interested.

And it’s much more than any of that. It’s kind of like saying coffee is a mildly bitter caffeinated beverage commonly drunk in the morning. While true, this would not begin to describe what it’s like holding a warm cup of java in your hands, the first sip, the mild caffeine rush, the associations you have with mornings like this … not to mention just the complexities of the taste. Or as a Zen teacher of mine in California used to say, “You can’t eat the menu.”

So while I could write ad nauseam about living in more aligned, freer body … it’s something else entirely to know that for yourself. In my experience, an SI series can be a really helpful tool in unearthing that alignment.

If you’re interested in directly experiencing a KMI Structural Integration series, feel free to send me a message, either with questions or comments, or to setup your initial appointment.

To being at home in your own skin, cheers, Liam

Sometimes the change is obvious and even a bit mind-blowing. Other times, the subtleties of experience begin to work their way in, a certain nuanced way of feeling and seeing deeper than gross motor experience, more refined.

The interesting thing about all this to me is that at the molecular level, switches are either on, or they’re off. The muscle cells are either firing, or they’re not. A neuron is either making the connection, or it’s not, across the synapse. A chemical receptor in the blood is or isn’t acting as a catalyst for a reaction. There is no such thing as a partially contracted muscle fiber, nor a partially fired neuron, nor a subtle variance of a reaction.

What we’re feeling, even in the most subtle of changes, then, is not a change in quality per se, though we certainly interpret it as such. It’s really a variance in quantity. As in, the amount of muscle fibers firing can change; the fibers themselves, though, don’t speak the language of gradation.

On or off. The most subtle changes are there in the very tissue of us, clear as day, on or off, this way or that. Interesting, then, that our experience often feels so different than this black-and-white reality, no?