Talkin' 'Bout (the Circle of) Willis

Let's talk about the back of the head.

The Circle of Willis is a series of arteries connecting critical feeds of blood to the brain. When a connection like this is created in the body--whether it developed that way or was created--it is called an anastomosis. An example of a synthetic anastomosis would be if someone had a section of intestine removed, and the two remaining sections were joined together.

In the Circle of Willis there are smaller arterial sections that would allow certain sections of the brain to be fed at least a little bit by arteries that wouldn't normally be tasked with doing the job, in the event of a failure like a stroke or other trauma. Smaller segments within the Circle of Willis are fed by the internal carotid arteries and the vertebral arteries. The internal carotid arteries are split off from the carotid arteries.

Here's a video. If anatomical terms aren't your thing, just watch as the video highlights where the blood goes.


We always talk in martial arts about protecting your face. Keep your hands up. Protect your jaw. Keep your chin slightly tucked. But all we say about the back of the head is not to let anyone get behind you. We know it's important not to get hit in the back of the head, or in the spine. Perhaps a lot of us would get psyched out if we all knew how catastrophic any blow can be.

Some of the people I support at work have survived a traumatic brain injury. Knowing the science behind their situations may not be at the forefront of my work with them in rehabilitation, but it does help me to be compassionate about what they may be going through, because I know what is damaged and why. I also know more about what can be rehabilitated and what can't. Because I am not a neuroscientist I cannot allow my novice understanding of anatomy to impact the recommendations I make, but it can help me ask better questions of those who are qualified to provide better information, and /that/ can improve my outcomes.

In karate, I use my knowledge of anatomy and physiology--and my knowledge about how my body breaks so many of those rules--to learn, grow, and adapt. When I know how serious a consequence can be, I know to sit out. Knowledge is power, and as Uncle Ben said in "Spider Man," "With great power comes great responsibility."

Last night I made it to karate and I'm glad I did! I did my first successful groundwork. It feels good to have studied anatomy and physiology. It feels incredible to see it in action. Best of all, it feels sublime to watch my lawless body doing what other bodies can do.

There are so many factors involved in success as a martial artist: how my body is built; how bodies are supposed to work; how bodies don't work; how bodies can be improved; how bodies can degenerate; how adaptions can be made; how practices can be improved; and so on, that it makes sense to say that karate is a cradle-to-grave activity.

The body has a lot of little fail-safes like the Circle of Willis. I enjoy learning about those redundancies, and I think it's a worthwhile use of study time because it also reveals the vulnerabilities.

No Excuses

"No excuses" bugs the hell out of me. Some "excuses" are bona fide reasons, and this saying hurts what is already tender enough. It does not motivate me one bit. It's doubly offensive when it's superimposed over a person with a disability going about their workout routine in an effort to get able-bodied people motivated by their guilt about not going to the gym. There, I said it.

#micdrop

How Can I Do Karate?

Last Tuesday I made it to the dojo for the first time in two long, miserable months! I was excited and terrified. No one around me seemed particularly surprised to see me there, and no one seemed to notice (until I opened my trap about it) that I was on hyper-alert. I was afraid of dislocating, passing out, or having my blood pressure plummet. For the start of the class I had fluids running and was parked on the bench until I could no longer sit up. Then I sat on the floor, propped up in the corner. Eventually the spasms got to be too hard to stifle, and I lay down on the floor, continuing to work in the air. For the end of the class, while we practiced kata in small groups, because I was able to take care of myself, I finished the class on my feet, leading Seiyunchin kata. I felt like a million bucks, and if anyone was fighting that day like H-E-Double-Hockey-Sticks, it was this guy. Nobody hassled me, nobody even looked, except to see that I was okay whenever I cried out in pain. Nobody thought it was unusual, or was distracted. After class was over, I got a couple of "Nice to see you"s and that was that.

EDS makes a person self-conscious. EDS does not have to make a person self-conscious. EDS does not deserve to make me self-conscious, because I am a Titan. Better still, I am a karateka. One is fictional, and one is not.

My blood pressure has been crashing to scary-low numbers, so I have been eating bouillon cubes to keep my blood pressure up. Chicken bouillon cubes. Normally I just drink the broth, delicious and sensible. But broth means volume, and volume means vomit. So, while my guts aren't Barfatron Central, I don't want to do anything to rock the boat and start the gastric spin cycle over again. My aid has been working with me to organize small meals that are what the medical field calls "nutrient-dense," but foods that are low-volume and easy to keep down. The easy solution seems like one would write a list of foods that stay down, and work from that. While that's a sound start, gastroparesis doesn't work that way; at times it doesn't matter what your intake, your output will always come out in the wrong direction, and you'll just have to have a little mercy for the fact that biology still has many mysteries.

My friend asked me, "How can you do karate with your health?" First I came up with a very fancy, clinical answer, then I came to my senses:

It's quite incredible, really. I have strict rules with my Sensei about every little thing: where is the best place to keep water and medical supplies, where to stand in front so I can lipread, how long to bow out for care and recovery. I only work with black belts, as they have the best control over their flying limbs. I keep my promise to take a break when I honestly need to. If I need to drop to my knees and finish a drill that way, or on my back, I can. As long as I keep doing whatever I can do, I get to play the reindeer games. :) When my legs don't work and everyone's kicking, I do punches that are similar to the kicks. Usually I'll do a few rounds of each drill as best I can, and then adapt when I know I'd peter out if I were to continue. Certain things are off limits, like being dragged around by my head, or certain conditioning that is deliberately intended to damage nerves. If it's not something I can adapt I just politely bow out and people reshuffle. I have a hiking backpack that I can secure well to my back while I'm exercising if need be, as well. Sometimes I'll do that, sometimes I'll just crawl to the floor next to the bench, put my feet up to push blood back to my brain, and work with my arms.

You know what? The real answer to your question isn't what I just wrote. The real answer to your question is that everybody supports me and adapts with me. Not even once have I been given a hard time for not being able to keep up. I have asked myself a thousand times whether I really deserve the belt I have. The answer is that I do, and I don't know anybody who would be able to perform like I do if they had my challenges. It's because of my dojo, that's how I am able to do karate.

His response:

I love both your answers to my question - particularly the second. "Everybody supports me and adapts with me" pretty much sums up the ideal society, whether it's a dojo or a nation. In a culture that reifies "individualism", it's great to know the community still has a place. And frankly, I think this is good advice for anyone: "Nobody drags me around by my head".

I also love your blog. More precisely, I love your love. It makes your life rich and full, and makes people like me want to be your friend.

That's a pal.


This morning I missed karate because of exhaustion and pain. But sleeping until 2pm seems to have given me a little energy to care for myself, and to refresh my brain. I'm not going to miss karate forever, and I'm starting to forgive myself for the absence, because every move I make is aimed at getting me back there, while doing good works in the meantime. I'm working on projects and learning new skills, which is working for me. Additionally, although I'm not ready to do drills, I still do juunbi undo (warm-ups), read Higaonna-Sensei's books, and study my kata. Today the class was not to be. Tuesday I'll try again. Twice a week is the target, but once a week may have to do for now.

Karate is not something you study on your own, you need a community. My Sensei has given me a worldwide community to learn with and connect with, including some people like me! My dojo is right here in my neighbourhood, and my community at large is just a few keystrokes away. This is good for me, and I'll keep at it, looking forward to returning as soon as possible.

Be well.

Deep Breathing and Protecting the Airway

Place three fingers right at the tip-top of your sternum, just inside of where your collarbones end. Now, gently turn your head from side to side.  When you feel your fingers move, you've found one of the points where your sterno-cleido-mastoid muscle (SCM) begins! The other is just a little bit farther out to the side, attached to the innermost third of your collarbone.  It's a muscle that helps with rotation of the head, and also lowering the head, among other things.   This tiny muscle is the HULK! Stick with me; knowing anatomy can help your practice, and can rock your sparring like a hurricane.

Every muscle has a point of origin (where it starts) and a point of insertion (where it ends).  The SCM has two points of origin!  It begins at the top of the sternum and the medial third of the clavicle!  Maybe this could be considered one big point, but because it attaches to two places, it makes sense.   The SCM comes together at the back of the neck.  This is usually injured if you experience whiplash.

Why is this beautiful?
Life has created an incredible tool for itself!

The SCM is a muscle that:

• Connects to two different body parts
• The sternum, which holds your ribs together.  That means the SCM is one of many muscles holding your rib cage in place so it doesn't tilt forward.  Imagine what this means for big-chested people: the SCM connects at the back of the neck, the Emerald City gates of all neurological function.  No wonder a breast reduction has serious beneficial implications on pain management.
• Changes direction
• Most major muscles have a "1 or 0" way of working.  The simple bicep either contracts or it doesn't.  The SCM is a muscle that everybody takes seriously.  A little injury can cause a lot of trouble.
  
  
  "And though she be but little, she is fierce."
  

  -William Shakespeare, A Midsummer Night's Dream
  
• Facilitates movement in many directions
• Lateral rotation of the head (side to side)
• Turning to follow the opponent
• Rockin' your very best kata
• Flexion of the head (up and down)
• Bending your head down to protect your airway
• Lifts the rib cage
• The SCM does part of the work of lifting the rib cage up so that you can take a deep breath, the kind that goes to your abdomen and makes you feel really good.
• Sanchin Kata
• Tensho Kata
• Tai Otoshi (body drop)

It's interesting that we have large sheets of muscle on the tops of our skulls because those bones are fused. One would think it would be thick connective tissue, although there is plenty of that, too. From my inexperienced perspective, the explanation may include that the muscles of the skull help facilitate developmental fusion of skull segments in babies, or working connection with the facial and jaw muscles. I've got to be missing something, though.

More info on the SCM:
http://www.innerbody.com/image_musfov/musc38-new.html#full-description

When I was studying medicine I had a place for these ruminations to go. Since I won't likely become well enough to continue my studies, I'm grateful that karate provides an outlet for my thoughts on anatomy and physiology (A&P). Ehlers-Danlos Syndrome (EDS) is a giant anomaly of A&P, but because I live with it at all times it isn't the healthiest place to nest all my curiosities. The lens of having EDS also produces distortions and bias, whereas karate is practiced and studied by a diverse population, and provides for more well-rounded thinking.

This whole post is a little heady (*snicker*) for a Sunday morning, but still fascinating to think about!

The Spiritual Part of Spirit Training

Spirit Training is where you train so hard that the only thing you have left to carry you out of the dojo is your spirit. We do it every six weeks and it's when Sensei really shines.

The greatest challenge for a strong person to remember is that they are strong even when they don't feel strong---or especially when they don't feel strong. Maybe today wasn't Sensei's best day. It was rainy, some of us weren't awake yet, and he is probably still coming down from jet lg after a recent trip.  Even so, we were all plenty drenched with sweat and satisfaction!

At times he lets us see that his feelings are susceptible to vulnerability like everyone else's. It is not necessary to know the details because the lesson is in how he takes care of those feelings. To see vulnerability in him while knowing his strength helps me remember that my own vulnerabilities don't hold a candle to my strength. Part of our dojokun is, "I will strive to have patience, kindness, gentleness, and self-control."  That's the hardest part when it comes to me dealing with my own health muss, so I really need the example.

When you're in this dojo it's just you. No frills, no fancy hairstyles, no hundred patches all over your gi, none of that. Everyone can see you and anyone can watch you. This makes it important to do one's best, because we all learn from each other, and we will pick up on either the best or the worst.  One of the burdens that Sensei and Senpai bear is that everyone is watching them at all times, and for different reasons. They are always modeling, whether they like it or not, and that's a lot of pressure.

To my horror, I was late when I thought I'd be early today! Having decided that I would go all out today, I jumped in and had a blast. The pain was under control, I just took breaks to let spasms relax, and I got through without having to run fluids during training.

At one point my thoughts began to get foggy, which is a fairly new symptom, as far as I'm aware (or willing to admit). I dealt with it by using the Scientific Method, which is easy enough to use for problem solving, good and rote! I listed symptoms, concerns, possible solutions, likely outcomes, then evaluated and selected what I thought might work best. This was my first time working through it on my own in the dojo, I always check with Sensei. I thought I'd try it on my own, and I did okay. My method was breaks and hydration.

At the end of Spirit Training today, Sensei did a Mat Chat, where we sit down and be tells us what he's been thinking about, what he's been working on, what he'd like us to work on. It's a special time for character development that comes just before those who tested and passed receive their belts.

Here are some things Sensei shared which stuck with me as meaningful and relevant to my training. (Note: The wording may be off a little bit, I lipread and he has a beard.)

"It's not about how good you are at karate. It's about how good karate is for you."

"Whatever you believe in, you need to follow it to its logical end and know beyond every doubt that it will sustain you. If it doesn't, it's false."

"You cannot look at a person's belt and judge that their karate isn't good enough. You don't know what another person went through to get that belt."

I'll leave it at that, so you can think about it yourself.  I'm going to go home and shower, I stink. :)

Be well.

Even Doubled Over Isn't Over Enough

Sensei gave lots of verbal instruction and demonstration tonight, so I was able to relax about keeping up. I learned a whole lot of great points about Saifa kata and bunkai. I consider Saifa my best kata, so a while night devoted to it was a treat!

It was especially a treat because this is my first day up after five days doubled over on the couch from gastroparesis pain. I've gone to work and slept, and that's it. Anything to keep the pain down. Nothing touches the pain. It's impossible to breathe without pain. If tonight had been a night to practice Sanchin I'd have been dead in the water.

I learned about how, when your body turns to do the knee-kick, your head turns because you are changing directions, so you need to continue facing the opponent.

In Bunkai we always push the opponent away after an application of the kata. It's a good base strategy to have, but it also signifies awareness (Zanshin) that the opponent is certainly going to attempt to counter your move.

The elbow break move is one of the most interesting bunkai I know. It's so simple, and it would be instantly effective on me, but I don't see myself ever developing enough strength to break the joint on someone else. Still, if I ever get control of my tai otoshi (body drop), maybe I can at least jar the person well and gain control of the limb.

While I rested I watched my karate family practice kakie (push hands). The black belts were more methodical in their movements while the -kyu belts were more aggressive. I enjoyed learning what I could from both groups, and comparing what I knew to what I saw.

It's always a struggle not to cry out in pain. Sometimes I can't help but let out a moan, which is frowned upon in self-defense, because it lets the opponent know you're hurt, and opens you up for further damage. When he's hurt Higaonna-Sensei says, "Thank you very much!" and continues on. Will I be able to cultivate that discipline? I don't know, but it's a good target.  Sometimes the strike or movement is tiny, but it sends a shock through my body like I've had a limb severed. Other times I take a direct hit and I giggle effortlessly. I don't understand nociception (pain perception) in EDS.

I did what I could tonight and was super careful not to push myself. There will be better days for going all out.

It would be arrogant of me to assume that Sensei did so much technical instruction and demonstration just so I could be included, but I can't help but think it delights him every time he sees me get up off the bench. I think most people in my dojo like watching me succeed as much as I like watching them succeed. (Well, maybe not that much--I'm a bit overzealous when they level up!)

After five days on the couch, karate is the first place I could think to go. There's nowhere I'd rather be. I think I've written it before that, die when I may, one of the rooms in my heaven will be just like my dojo. I don't have a lot of expectations for heaven, but it won't be heaven without this room.

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.