On Static vs. Dynamic Exercises and Stretching*

"If you can't explain it you don't know it well enough." -Einstein

It's been three years since my last belt test. I tested for 1-kyu in Goju Ryu Karate on November 11, 2020, via Zoom online. My tests are adapted to suit what I can physically do, which is largely kata (forms) and solo kihon bunkai (basic applications). I also need to understand what others can do with the system, and I need to be able to adapt what I can't do in such a way that it would work in the street. This was set from Day One with my Sensei in a meeting that lasted for four hours while we sussed out what my training was going to look like. That was about nine years ago. That's a long time to be a kyu-level belt (non-black). But some people never get this far.

The notes below are a summary of what I've learned about muscles locking up intensely and painfully. My port and daily IV fluids must have been preventing these problems for years. I'm grateful for seven years with my port, it's unprecedented. My medical team is incredible and the value of a supportive Primary Care Physician cannot be understated. For over two years I've been in Physical Therapy and Occupational Therapy, among other rehabilitative efforts. I've also beaten the grave four times, retired, started a small business, bought a new-to-me mustang (I love mustangs, it's like getting a limb back), while also living through the pandemic and attending karate to the fullest, safest extent possible. (That's another story worth telling and this little note is to remind myself!) None of this is medical advice and don't trust everything you read on the Internet. I haven't even run this by my PTs yet.

The Ehlers-Danlos community has already benefited from my Sensei's leadership by observing and trying these methods. My Sensei has also been actively outspoken beside me, and others, teaching people with all sorts of abilities that martial arts is for everyone, that our school welcomes everyone. He's helped lots of us unpack negative experiences with instructors who pushed EDSers to the point of injury or quitting. 

Indomitable acceptance in the dojo is founded in the school's Christian values, and people of all backgrounds are welcome. If I were Jesus that's what I'd want to see. Anyway, on with the science notes: 

On Static vs. Dynamic Exercises and Stretching*

• Given
• When the muscle must contract it's happy to do its job, even if that job is a little tougher because of instability.
• When the muscle must relax, those fibres have no idea where to stop because tendons aren't stabilizing or providing usable feedback. So, the muscle is inclined to remain contracted: "Any time now, tendons.... Guys?"
• Interventions: milieu approach, e.g.,
• Isometrics give the muscles a chance to practice both strength (muscle's ability to contract)
• Short, sustained reps for tone (muscle's ability to remain contracted), and 
• ...also releasing and relaxing in between reps (except they suck at relaxing).
• Manual therapies aid in the physical release of muscle fibres which can only relax passively.
• Pharmacology aids in the chemical release of muscle fibres, which are chemically gated by extraneous sympathetic activity, hormones, diet, exercise, psychology, family hx, etc.
• Things I couldn't fit elsewhere
• Timing - time of day/month; interventions before/after activity; last meds, food, hydration, electrolytes
• Psych - last boost of oxytocin or dopamine; last interpersonal reaction; psychological flexibility; emotional regulation; cats?
• Environment - weather; climate; physical safety risks; fall risks
• Adaptive equipment - tapes; braces; splints; mobility aids, environmental mods
• Support - care team; community members; friends; family, and access to them all
• Misc - what else is hurting (and what isn't!); energy levels; cognition; quality of above factors
• If a muscle group isn't working right, check the opposing muscle groups.
  
• Ongoing "learning opportunities" (that aren't necessarily functional goals, but are more qualitative)
• Emotional endurance when things look bleak for a long time
• When I get sick, any of this knowledge that isn't rote goes out the window.
• Prevention and managing crashes (exhaustion, injury)
• I forgot how to know when a muscle is fatigued vs. exhausted, and when that's a useful vs. hazardous.
• WTF, diet/guts?
• Consistent exercise program
• Managing kinesiophobia and coping without a port like a freakin' boss
• WTF, mind/body connection?
• Communicating with providers succinctly ;)
• Things to remember
• "If you can't explain it you don't know it well enough." -Einstein
• I didn't come this far just to make it this far
• I must rest when my rampage is over
• Didn't cause it, can't cure it, might bitch about it, can endure it.
• Nourish to flourish
• Take your meds. Your doctors know they're not prescribing Jolly Ranchers. (that's mine!) :)
• Sometimes to let it heal you have to stop fuckin' with it. (also mine) :)

Be well. Whatever you celebrate, Happy That!

*I am not a medical professional, so check with one. Don't believe everything you see on the Internet.

"Watch and Learn" is a Thing

"Watch and Learn" is a thing; I'm a hypocrite if I could do that thing, but then don't.

If you have Ehlers-Danlos Syndrome and practice Goju Ryu karate, you'll need to practice adapting. I am a star at adapting, with plenty of life experience. What you do on the floor has to work in the street or it's of no use. Observing gives me an opportunity to watch and think about adaptations without trying to stay conscious and upright.   

For both Monday's and today's appointments I did not get medically cleared by my physiotherapists to attend the once-in-a-lifetime Gasshuku (special karate group training) this weekend. The Gasshuku is with 8th Dan Paul Enfield, and it was the right call: my sacrum won't unlock. If I try to use my lower back I'll be very sorry for it later on. Throwing punches without full access to my hips is causing my clavicles and shoulders to sublux. Kicking with a fibula that won't stay in place unless it's taped, or suri-ashi (body shifting) with an ankle that won't stay in place, is not a good idea. All this, right after finally figuring out a way to reduce the blacking out from Dysautonomia. Any one of those things would be reason enough for any rational human being to sit the heck down.

But this is Paul Enfield, the man who brought all four volumes of Higaonna-Sensei's work to document Goju Ryu karate to the English speaking world. Sensei told me to come and observe, and usually I would be able to do that, and happily. PT suggested the same. But I'm deaf in the dojo, so it would be complicated and stepping into the dojo is already so emotionally charged that I can't imagine being isolated in two ways (movement; hearing). That's an error of thinking, though; I am never separated even when I'm just observing because my dojo family goes out of its way to make sure everyone on the floor is included.

I dread sitting out because I put everything I have into physical therapy to get back to karate. It feels like I'll never be done rehabbing, and it's true that I'll never be done with rehab. PT is a permanent aspect of life with EDS. But rehab without karate feels like I'm fighting just to live, and my quality of life feels pretty low since the third bout of sepsis.  I also miss my port and the freedom to roam whenever and wherever I want to go.

It's hard on the psyche to go to the dojo and not physically participate. Sometimes I have to step out to cry, which is fine, but tends to make others worry. "It's just hard," I tell them. And it is. The pain of knowing my body will work against me if I try to use it is agonizing in itself. It's arguably worse than the physical pain, but because the physical pain affects my overall functional level (like being able to use the bathroom), I have to respect the pecking order of matter over mind. 

It won't be forever. Sensei assured me that there will be plenty more Gasshukus. But my heart is in the dojo and I want to be doing karate. No matter how much I read or review while I'm physically rehabbing, it's no replacement for live practice. Not being able to practice also has a detrimental effect on how much I can learn through studying, too.

What I'm trying to say is that I'm upset when I don't need to be, and if I want to be a hypocrite I should stay home and not find ways to adapt what I'm seeing. And yet, I feel pretty rotten. But even when you feel rotten, you should go to karate.

Tai Sabaki and Shifting Directions

Tai sabaki is a shift but it is not a final destination, you have to keep moving.

PT didn't clear me for karate this week so I'm watching videos of Higaonna-Sensei. My goal is to find one physiotherapy modality that will help me develop the functional muscle movements and stability to perform one thing a little better than before.

My focus has landed on tai sabaki, body shifting, which can also be translated as body management. Defensively, tai sabaki is used to move quickly out of the way and often includes facing a different direction.

Since my last three hospitalizations I've had to dramatically switch directions in my life. Switching directions shifts one's vantage point, which allows for refocusing. In fact, it requires refocusing, if you're going to get anything done. Tai sabaki is a shift but it is not a final destination, you have to keep moving.

The hips drive tai sabaki. The more stable your core, the better the control. Faster, stronger, easier, smarter. Less easily fatigued. More readily engaged.

PT has been incredibly hard and slow to progress. I feel less likely to fall but I'm still too weak to do a number of functional tasks. For instance, I can't go out to buy groceries and then also put them away when I get home. It has to be done in steps with rest in between.

With tai sabaki you have to stay relaxed, "not too busy", as Higaonna-Sensei explains it. If you get anchored down you can't move or change when you need to. My PT is good at changing directions and finding new approaches. It's not easy work to manage my frustration when a task doesn't work out; a quick shift of focus keeps my time in PT productive and developmental, even if it's not the original task I set out to accomplish.

The goal is to get through, not to land a particular punch. That's why you have to be able to shift, and to practice all different kinds of things. A little at a time, all those little efforts add up to the win.

https://youtu.be/8Ru-fQ10c3Q

Recently I had a nurse evaluation, one of many. "Staying alive, is that what your goals are with your doctors right now?" she asked. Yes, that's the primary goal right now. But it's leveling off and the shift is toward recovery and functional goals for Activities of Daily Living (ADLs). Karate isn't on the list as a method right now, even though it involves exercise. But that doesn't stop me from asking for clearance to go each week. That's the direction I want to be facing, even if I have to shift now and then.

Physiotherapy-Do

Physiotherapy (PT) has its methods. It takes time and commitment. It takes energy and resources. It's for a better overall sense of being. In that sense it is just like karate-do, another way of being. It's hard to walk both paths at once because my energy is limited, so I've been foregoing karate in order to repair my body at PT with that much more focus and efficacy. When I pushed myself to do both I felt like I was working against myself because I was too sore and exhausted, and I was getting weaker from doing too much. (I do not enjoy admitting this.)

After physiotherapy today I had to sit in the parking lot to collect my emotions. My physical therapist is so knowledgeable, so humble, and so unafraid to try to help, that I get overwhelmed by finally having a place to go where I can get relief. (I get even a little more overwhelmed to think of how few EDSers get this far.)

Thanks to my PT's help, I take less medicine for pain. I am getting through more of a day without needing a major rest period. I'm not throwing up every five minutes. I'm passing out less often, and less severely. I'm able to hold my own head up without a brace more often.

Regular access to competent physiotherapy is helping me get ahead of my pain. He not only helps me understand what's happening, but he challenges me to think through why it is happening. Then, he gives me options for what to do about it, and I am 100% included in my own care plan.

My PT meets me where I am in managing my symptoms. By that, I mean that he genuinely listens to my confusion and frustration, which gives me space to work through the emotions that need care on the way back to logic. It's a holistic approach, invaluable to a "PT lifer" like me.

I look forward to physiotherapy because it's where I go to get better. Today I was anxious because I knew I was going to be able to make it, but I didn't know how much I was going to be able to do since I had been dealing with POTS all morning. I had a "painsplosion" last night, too, which was not helpful. What I did know was that I would be okay, and that I would be in less pain after. I would not be judged as weak and I would not be ridiculed for using dramatic terms to describe my pain because it's so complex a feeling to convey. I knew there would be things to laugh about and that I would have some serious work to sink my teeth into. 

I like working with my PT because he is a natural teacher like I am. He lifts up everyone around him because he is constantly educating. Patient education is essential to long-term results. I leave with lots of ideas to look up each week. I wish I could stay and take more notes during or after sessions, but I really need to focus on my body so I can get back to karate. That means I don't get to spend as much time in my head as I'd like, to process it all. With hearing loss it takes extra time to commit verbal exchanges to memory.

Physiotherapy has been a long road for the last several months. It's taken effort, tears, trust, time, and patience. Not once have I left there feeling like I haven't raised the bar; I am always a little better off than I was when I went in, regardless of where I was when we began our work.

Because I'm able to get this care, in able to stay employed. I'm able to earn a living wage, pay my bills, contribute to the economy, and even make a few modest donations here and there. Ehlers-Danlos Syndrome costs a fortune to manage, even with Employed Individuals with Disabilities Medicaid buy-in to cover my insurance copays. A significant portion of my wages goes into my care. But at least I'm getting adequate care now, which is especially true with having found a qualified and competent provider.

Last year was a rough year for my health. This year I'm going to keep working on improving myself. I will work to remember that I can only do one thing at a time, and I will try not to work against myself.

I'm so grateful that the trend is upward that my eyes are leaking. You could fill a city with the number of people who are a part of my progress. If we could measure compassion in raindrops I'd need an ark!

The foci of our work this time around in PT has been on shoulder stabilization, stabilizing and integrating the paraspinals, improving vestibular resilience, resisting syncope and recovering sooner, and a few other odds and ends.

I am so eager to get back to karate, I must think about it at least 20 hours a day. But I don't want to overdo it and end up injured again because I'm working hard on PT to come back from a really harsh year. Every day that I don't go to karate I have to resist kicking myself. But I'm trying to be patient with myself because I still study and I still practice at home, which has value. My dojo always welcomes me to try everything I think I can do. But I think I'm doing the right thing to let myself recover. It's so hard to not go.

I'm so very grateful. How I wish I could give this experience to others who desperately need better care and better results. Maybe by writing it up, others will know what to expect, and they will know to aim for a higher level of care.

Be well.

Adapting Gekisai Dai Ni Kata

https://youtu.be/0Uydn4yEXe4

Gekisai Dai Ni is my hardest kata. It's extremely hard on my joints because of the rounded techniques, which take place on all three planes of motion: coronal, sagittal, and transverse.

For Ehlers-Danlos Syndrome, movements on one plane of motion are best. Movements on two planes of motion are okay. Movements on three planes of motion are a no-no because they most strongly force the joint into a closed-pack  position, with the highest congruency. In plain English, they mash the joint into its socket or capsule the most tightly, which gives it lots of opportunities for the stabilizing tissues to snap, tear, break, sprain, and so on.

Coincidentally, in a hypermobile person, a position at the end ranges of motion, with the most joint congruency, is often the most comfortable: everything is as tight as it can get. Many EDSers enjoy sitting with our legs contorted in unusual positions because, if we pin our legs down as far as they can go in any direction, we at least know where they are, and that they're tight. It gives a false sense of hope that our limbs will stay put. Over time, repeated activity at the end-range of motion will lead to further laxity and weakness. Then, when we need to do normal things in more reasonable ranges of motion, we fall apart easily and don't know why. (Well, now you know why.)

All kata in Okinawan Goju Ryu Karate feature rounded movements ("tripled" movements, when referring to planes of motion). It's one of our fundamental ways of moving, and for some applications it is indeed the most stable and effective.

With EDS, I reduce a lot of my dislocations by simply reducing my range of motion to five degrees fewer than the average person would move (which is 15-20 degrees fewer for me, and I'm EDS Classical Type, not even Hypermobile Type). It took six months to learn to walk this way, and six years to learn to live this way.

In karate, I reduce my stances, especially Sanchin-dachi (Three Battles stance), by just a few degrees. I have three goals with my stances:
1. Don't dislocate
2. Get the same functional outcome
3. Get the same aesthetic outcome

There are times when, curiously, I lose control of my legs. I can be standing, but unable to move. My fellow karateka will sometimes remind me what to do or encourage me to take the next step because the delay is very noticeable, but I'm stuck! EDS is given to neuropathy and radiculopathy, but I've never seen research on momentary paralysis. (Perhaps it's a Chiari-I Malformation thing. I haven't jumped down that rabbit hole of research because I don't have it yet.) I finish the exercise and then take a break. Lack of control of major muscle groups is at least a sign of fatigue.

For upper body movements I have the same goals with my thumbs, shoulder blades, and wrists.  It's even harder with my upper body and I stand a good chance of being sore in the clavicles and ribs for weeks if I ignore those goals. It can interrupt my breathing, and make me even more susceptible to blacking out. I'm getting pretty good at managing it, though. I keep my knees bent and my eyes open until my vision comes back. I don't fall over anymore.

Gekisai Dai Ni is my hardest kata. I took second place in a tournament two days ago, but popped my ankle in the middle of the first neko ashi-dachi (cat stance). Stupidly, I finished the kata, because I didn't fall over, and my head was in "the zone." When I stepped on my busted ankle for the second neko ashi-dachi, I knew I'd made a big mistake. I took care of it immediately after.

My ankle already been coming loose for days and I ignored it, since that's not uncommon. Rookie mistake. I was so pumped for the tournament that I didn't pay attention to my body, and that's where I went wrong. I splinted the next day, but the pain crept up into my knee and hip, so that the whole leg was wrecked by Saturday morning. I missed out on Spirit Training and the karate family Potluck, both of which are highlights of my entire karate life. Instead I'm in bed with my leg elevated, blogging about planes of motion.

For some joints I've learned to finish kata with a dislocated joint, and put the joint back in place later on. It just pops out again if I stop and try to fix it in the middle of a kata. My fellow karateka are used to hearing me popping bones around, so they don't freak out, which is great for my emotional health.

Gekisai Dai Ni is my hardest kata. I need to practice it. I need to modify it and practice that. I could always ask for a different kata, but I want to master it in my own way, even--especially--if I can get through it with adaptation. That's the name of the game.

The best part about my second place ribbon is that the person who took first place has been working very hard on his performance, and he's worked with me on kata a lot! He deserves that blue ribbon, and I'm proud to take second. What a great memory, to compete next to someone who has worked so hard, and for much longer than I have!

Be well.