Seven weeks post op and, except for my new four inch long tattoos (scars) on each hip, I am forgetting that I had surgery almost two months ago. It is incredible to feel how the body integrates new parts so rapidly, seamlessly. Unraveling of twisted tissues and bones continues, as my body now learns to trust the stable, mobile efficiency of shiny new hip joints. Patient assertive work is critical. Defining the delicate balance point between aggressive retraining and gentle compassion in allowing the body to heal itself. As I teach my students, I aim to be an assertive and attentive coach, pushing to the edge of efficient movement, stimulating musculoskeletal nervous systems to upregulate and rebalance, without overtraining or compensating or steering the body into an inflamed state. Rest and recovery have become great friends of mine and feel how strongly they are working for me.
The past two weeks have allowed me to feel a gradual shedding of rigidity in my right hip, but a pain in right psoas…so great that each swing of my leg brought an internal grimace..has been limiting. Stretching exacerbated the pain. My nervous system, seeking to stabilize the hip joints, responded to stretching by bringing back tension back with a vengeance. I turned to strengthening, balance training, pilates, and integrated neuromuscular work. But the key I found last night…the irritation was coming from my lumbar spine and nerve pain was radiating into my right hip, causing my right back and psoas to clamp down. My system was working overtime and acupuncture and cupping (thank you Corie Tappin at Soulspace!) to my spine freed me to move without pain. My stride is becoming more graceful again as my psoas is not clamping down to protect my lumbar discs and nerves. While wobble board squats, banded side walks, lunges and hydrants have been instrumental in building my hip strength and stability, it is working on the reformer today that helped me really tap in to my central strength and alignment, providing key stimulus and feedback to strengthening my center line and rebalancing the systems around my spine. I am working to be attentive to vulnerable areas that I have braced around for years, and now to strengthen these deep core areas that have been dormant, perhaps due to injury, and move from a strong foundation.
It is quite common for the psoas to clamp down and hold on to stabilize after hip replacement. The gluteals and rotators of the hip are stretched during retraction in surgery, and need time to heal. The psoas wants to be a super hero and save the day by supporting everything. My own situation was complicated by ten to twenty years of psoas dysfunction preceding surgery; something I have learned to retrain by standing from my core and reaching through the tube of my legs rather than hanging on my joints. My left side, by comparison, is pain free and soaring forward with no complications.
Breakthrough with the ALT-G Anti Gravity Treadmill
In seeking to hlep me stop compressing my right side and swaying to the right as I stepped on my right leg, my savvy PT at BodyLogic, Ethan, decided to put me in the Alt-G treadmill. With its corseting set up, the treadmill holds the torso in place and lifts weight off the legs (somewhat like a jolly jumper for adults), allowing my hips to feel decompressed. This was revolutionary! By alleviating compression (I was walking at 65% body weight), my pelvis began to feel like it was floating, and my psoas began to lengthen in a way it has not in years. I began to walk with longer strides, my legs actually extending behind me, as I pushed the ground away with a strong toe push off activating my glutes and extending my hip flexors, rather than reaching in front of me with my hip flexors and pulling myself forward. The experience was like rebooting a buggy computer program; my gait had been programmed in a compromised way with impaired hip function; although my hips had been replaced, the mental program kept running until I consciously reprogrammed it with the assistance of the treadmill. This was enhanced by cameras focused on my legs, allowing me to see the action of my own legs as I walked, in this way, I could focus on long strides, extending my legs behind me, pushing off with the ball of my foot, landing with my foot underneath me, and the pattern of heel strike to push off through my foot. I was elated to feel this! It was like my hip flexors were getting a massage while I walked, being allowed to dynamically lengthen for the first time in years. It was an incredibly liberating gift to receive, teaching my brain what it is to walk with a healthy gait pattern. And the truth was seen as I stepped off the machine. The new program was set and I walked across the room with strong, fluid, balanced strides.
Also fascinating is noticing the drop in inflammation in my body. Bone on bone hip joints are ripe with inflammatory factors that elevate stress on the entire body. Upon removing the eroding joints, my body is beginning to thrive again. My acupuncturist, Corie Tappin, noted my pulse and tongue qualities (key determinants of health in Chinisese medicine) have dramatically improved. Swelling in my ankles has disappeared. My energy is better and I am sleeping through the night, a critical player in all of health.
Thank you to all my fantastic team mates on this journey, guiding me to new discoveries and breakthroughs. May I be a better teacher to others, as I continue to learn more with each new step.
Best to all,
Summer is in full swing, and it's great to be back in action with all my students and classes at Malibu Fitness. I wish you all a happy July 4th celebration ahead, and a month full of adventures in the outdoors. Strong, healthy core engagement and postural alignment are the foundations for optimizing our enjoyment in hiking, surfing, swimming, biking, rock climbing, and adventuring of all kinds. Enjoy the strength, flexibility, alignment and control that pilates can add to your sports and your daily experience. In addition to its affect on physical performance, how we hold our bodies in space affects how we feel about ourselves. One of my favorite TED talks by Amy Cuddy highlights how our posture affects how we actually think, and relate to the world. Stand tall and feel more confident, powerful, joyful, and purposeful.
Happy Summer to All!
Week four post op has been very inspiring; walking barefoot on the beach (no crutches!) and swimming in the pool are revitalizing. As my hips become more powerful and mobile, my gait is becoming more fluid and at times I am forgetting that I had hip surgery a month ago. Gone are the sharp pains stabbing in the front of my right hip, and the popping/grinding that felt destabilizing in both hips. It is elating to feel that when I take a step, my legs are solid underneath me. I feel strongly supported for the first time in a long while. I knew that my nervous system had previously been working overtime to analyze how to stabilize my body on what began to feel like stilt-legs. Uncaged, I now move with confidence that my legs are strong underneath me, without stabbing pains, and my mental energy is liberated for higher tasks.
I am deeply grateful for all the support I have been granted; especially nutritional and movement coaching both pre and post surgery. I am compelled to emphasize the key role that early physical therapy (PT) has on rapid, effective rehabilitation. I recently learned of a woman who had a single hip replacement in March, and is still very limited in her movement and requiring a walker. Her current therapists believe this is due to lack of effective PT immediately after her surgery. Her complications might have been prevented had she had immediate access to an effective physical therapist and rehab exercise program. I know efficient movement coaching has been critical to my rapid progress. and encourage anyone contemplating joint replacement to organize this ahead of time.
Also, I must emphasize the healing power of food; fueling the body with nutrient dense, whole foods --both before and after surgery--sets the foundation for strong healing. My personal preference is a plant based whole food diet following the paleo principles. Bone broth, organic grass fed meats (including organ meats), wild fish and plenty of organic green vegetables (2/3 of my plate is covered in veggies) provide a winning combination of bone building, tissue and gut healing nutrients. For more details on key nutritional considerations for bone and tissue healing, please refer to my previous blog entry, Bone and Connective Tissue Health, Speed Your Healing, (http://blog.ideafit.com/blogs/jennifer-beamer-fernandez-2/bone-and-connective-tissue-health-speed-your-healing)
Now it’s time for a dive in the pool!
Wishing you health and vitality,
It has now been three and a half weeks since my surgery, and I am quite amazed at how natural my hips feel, and how rapidly progress is occurring. I have no sense that foreign titanium parts are set inside my body; rather I feel more integrated, and connected than I have in a long time. The challenge is to reawaken stabilizers that have been dormant for some time, and unwind destructive tissue tension (hip flexors, adductors and rotators), that developed over decades to stabilize eroding joints and to protect me from pain. Now the real work, to realign and rebalance around highly efficient hip joints, has begun. For the first time in many, many years, I am able to align my hips, knees, ankles and toes properly; and my neuromuscular system is learning to connect the dots to support it.
I am tremendously grateful for my rapid recovery. I attribute this progress to a combination of factors; being dedicated to healthy living and committed to daily prehab and rehab exercise programs; maintaining a positive, focused mindset; having a supportive medical team and community; and of course, the brilliant work of Dr. Jason Snibbe (http://snibbeorthopedics.com) and his Direct Superior Approach, leading to optimal recovery and return to high function without restrictions. While previously practicing the PATH approach, Dr. Snibbe was determined to develop a method that allowed for faster recovery time and better outcomes. After brainstorming with a few of his highly trusted colleagues across the country, the Direct Superior Approach was born. This involves one small incision, minimal muscle trauma, and minimal structural damage –the piriformis tendon and a small flap of the hip capsule are cut to allow access to the femoral head and acetabular rim, but later resewn). This spares the iliotibial tracts (IT band) that is critical to pelvic stabiliation, and spares the gluteal muscles (the tissues are carefully separated rather than severed). This is in dramatic contrast to traditional hip replacement where all gluteals and external rotators are cut. With the Direct Superior Approach, one has less muscle trauma and, therefore, a much faster recovery. One normally stands and walks the same day of surgery. Highly computerized imaging during surgery ensures utmost symmetry between the legs and return to precise, integrated movement.
Dr. Snibbe chose a Stryker Dual Mobility hip implant for me. With it’s combined high range of motion and stability, this is guiding athletes to return to their high levels of performance. Its longevity record (an upwards of 25-30 years and more) means there is a high possibility of never needing a revision.
Returning to daily function is rewarding. The joy of being able to care for oneself is so refreshing; for example, I had forgotten how much mobility it takes to tie one’s shoes! After a week and a half, I was cleared to return to driving, and to teaching part time. Dr. Snibbe advised me to keep moving while being conscientious of the six week critical healing period, during which time the bone is ossifying around the prosthetics; jarring movements or overloading would hinder healing, while gentle, focused weight bearing and exercises, focused on activating the hip complex, will advance progress. My days are filled with movement, including my personal practice of an hour long exercise program twice a day (guided by programs created initially by Andrew Droll of Home Health Physical Therapy, and advanced by the therapists at Body Logic, Westlake), multiple walks, stair climbing , 20-25 minutes on the stationary bike., and training with light arm weights. Rest periods throughout the day, and a full eight hours of sleep each night are priorities. Rest is where the work of rebuilding the body happens.
I am a sponge for new movement information, and am avidly soaking up the teachings of the therapists at Body Logic. They assure me I am well ahead of the curve, as I ask them intricate questions about why my body is responding in various ways to the surgery and recovery, including irritating hip flexor and rotator tension. Initial programming is focused on activation of the gluteal complex, followed by strengthening in weight bearing positions. They have introduced me to an intelligent system of rehabilitation, Dynamic Neuromuscular Stabilization (DNS), developed by Pavel Kolar, PT, PhD, a Czech physiotherapist. According to DNS theory, core stabilization is achieved through precise coordination of the abdominals, spinal extensor, gluteals and associated musculature, and intra-abdominal pressure regulation by the central nervous system. I found this paper (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578435/ ) helpful in understanding the principles of DNS . It is interesting to find the parallels between DNS and the breath-work, alignment and stabilization techniques I have learned in pilates and my training as a physical therapy aide at Core Conditioning Physical Therapy. I look forward to bringing this more to my students in the studio.
I am fortunate to have a wealth of movement experience to draw upon in this retraining process, and am eager to share the information to help others navigate the complexities of joint replacement. My studies in pilates, dance, physical therapy, medicine, holistic health, posture and alignment (Esther Gokhale merits special mention) are guiding me to learn how to turn systems on in a natural, integrated way and propelling me forward to my movement goals. Please feel free to contact me with your questions or to share your insights. Let’s help each other get unstuck and move forward to pain free, revitalizing movement.
To your health,
I am now two weeks post op, bilateral hip replacements with Dr. Jason Snibbe, at Cedars Sinai Hospital, Los Angeles, and elated to be walking, climbing stairs, and living my life without pain. Taking this step by step, and honoring the healing process, I am moving at a pace that is much more gentle and attentive, than I am used to. And there is so much information at this pace, leading to rapid advances. This is a fascinating journey. Learning to walk again, with hips made of warrior style titanium, takes vast amounts of energy. As my body emerges from medications and anesthetics used in surgery, my normal high energy is returning and my mind tells my body to spring into action. My body responds with enthusiasm, but also emphatic reminders that I just had canals drilled into my femur bones to accommodate the stealthy new titanium shafts upon which my new ceramic femoral heads dance upon, encased in polyethylene liners, all housed within the titanium rim that now my pelvic bones are becoming very neighborly with. As my body recovers from surgery (indeed, a trauma of sorts), my liver, kidneys, lungs and lymphatic system are working overtime to detoxify from an array of foreign chemicals introduced in surgery and post-op (astonishing how this all occurs relatively pain free), my bones and tissues are working overtime to rebuild, and my nervous system is at the helm, taking in all kinds of new information and integrating these new bionic Stryker Dual Mobility hips into my entire system for the intended goal….Strong, efficient movement forward. (photos are coming!)
I am astounded at how the body and mind adapt so quickly to new challenges. After only one day, I was up and walking (with a walker) and by day 2 doing stairs. Progress would have been even faster if it had not been for my very low blood pressure, leading me to dive into lightheaded oblivion every time I stood up. Day two BP hovered around 73/33 on standing. Such orthostatic hypotension (dips in blood pressure with changes in position) is apparently common in healthy athletes after surgery. Not due to extensive blood loss, but to a phenomenon called third spacing: the blood vessels become highly permeable, as a result of a complex cascade of chemical inflammatory changes in surgery, allowing fluids to escape from the vessels into the interstitial space (between vessels and tissues). The vessels cannot accommodate quickly enough to changes in position relative to gravity, and blood pressure plummets. My doctor reassured me that my healthy body would soon recover, and sure enough, after a day of increased fluids and protein intake, I was standing and walking, without stars dancing in my head.
Welcome aboard new hips. Prior to surgery, a good friend reminded me to thank my old hips for all they had brought to my life. Rather than be frustrated by limitations brought on by extensive arthritis, bone spurs and cysts growing in response to bone on bone friction, I embraced a spirit of gratitude for the incredible journeys my hips had taken me on…dancing around the world, overcoming the obstacles of starting professional training at the late age of seventeen, my facility and determination led me to a wonderfully vibrant dance career. Indeed, I had left my third year of medical school at UCSF to embark on opportunities to dance in Paris, France. Though initially intending to go back to finish my M.D., my dance career had taken off, and was leading me to incredible new discoveries in ways I could contribute to the world. Seeing the excitement and gratitude in people’s eyes in Belarus, Poland, Germany, Russia, Scotland, and the US, and hearing how performances brought new inspirtaion to their lives…. feeling my mind and body focused in an extreme state of focused harmony…this fueled a new stage in my life, and I embarked on a fifteen year dance career, starting in Europe and maturing with Liss Fain Dance in San Francisco (www.LissFainDance.org). See them perform this weekend at Yerba Buena Center for the Arts, SF. More soon....time to go for a walk!
Best to all,
Thank you for your stream of support and kindness. This has propelled my healing forward. Thanks to my all star surgeon, Dr. Jason Snibbe, innovator of the Direct Superior Approach, my community, and health, I am now two weeks post surgery (Bilateral hip replacements) and back in action. It is fascinating to learn to walk again, integrating new high tech parts into the complex system of the body. I am astonished by how quickly this occurs and will be writing about the experience, here in my blog, in the coming weeks. I look forward to dancing and moving powerfully again, and guiding others to their own vitality and strength through movement. This journey continues to deepen my respect for the body’s power to heal, and generates empathy for those in pain or instability, seeking the keys to unlocking their potential for powerful movement. May this experience make me a better guide to others. I am back in the studio part time this week and looking forward to seeing you soon. With gratitude to all, Jennifer
Last weekend I was honored to be back in the hallowed lecture halls of the UCSF School of Medicine for the Evolution of Medicine Symposium, led by Dr. Akil Palanisamy. It had been 16 years since I had last attended lectures at UCSF and a rush of adrenaline shot through me as I remembered my transformative experiences there. It was at UCSF that I had embarked upon a career as a doctor (which shifted as I took time in my third year to dance in Europe...time which expanded to a 14 year dance career), spending sacred time with patients, learning their stories, understanding their deep desire to heal, searching for answers, and feeling the influence of the pharmaceutical industry and conservative viewpoints on the practice of medicine. A myriad of memories showered upon me. It was fascinating to be in the UCSF lecture hall and to reflect upon where I was then, as a student, in terms of what I believed about the role of medicine and the art of healing…and where I am now, after a career as a dancer, healing from many injuries and conditions such as arthritis and osteoporosis, and now teaching pilates and wellness. The importance of diet, lifestyle, movement, and behavior upon one's health cannot be understated. The Evolution of Medicine symposium, organized and moderated by Dr. Akil Palanisamy emphasized this.
The all star panel of presenters, including Robb Wolf, Chris Kresser, Chris Masterjohn, Michelle Tom, Stephan Guyenet, and Justin Sonnenburg not only brought extensive scientific research to the audience, but framed it within the context of tangible steps to integrate the information into a meaningful plan for healthcare practitioners.
Robb Wolf began the presentations, taking a look at medicine from an evolutionary perspective. He illustrated how the transition from Paleolithic hunter-gatherer society to Neolithic agrarian society gave rise to Western diseases (diabetes, cardiovascular disease, diabetes, obesity, and autoimmune disease). This shift also marked a dramatic decrease in diversity of gut flora, and a rise in gut inflammation. The prevalence of lectins in grains has been linked to leptin resistance and decreased glucose tolerance. Gluten increases gut permeability and inflammation throughout the body, even when no symptoms of gut irritation may be present. This is expressed as an array of suboptimal health conditions, including aching joints, fatigue, brain fog, and hormone imbalance, all of which indicate inflammation in the body. If allowed to persist, this progresses to the inflammatory disease states of diabetes, CVD, obesity, autoimmune disease, and more. Loss of intestinal barrier function ("leaky gut") is inherent in the development of autoimmune disease, a condition born of the agrarian era. Take home points from Wolf: avoid gut and microbiome irritants such as refined foods, acellular carbohydrates, gluten and sugar, while increasing intake of vegetables, nuts, seeds, fermented foods, and fiber which gut bacteria thrive on.
Dr. Akil Palanisamy, author of The Paleovedic Diet, combines western medicine and the wisdom of Ayurveda into a holistic integrative practice. He took the stage to explain how the balance of one's true dosha nature, Vata, Pitta and Kapha, leads to wellness and healing from within. Imbalance in the doshas, induced by the stress of toxins, relationships, social isolation, and unhealthy diet, leads to disease. He shared some culinary pearls to maximize the nutrient value of foods; eat whole, organic, local foods, rich in a diversity of color, consume antioxidant rich skins of fruits and vegetables, organ meats and spices. These are described in detail in his book.
Michelle Tom, a UCSF pharmacist turned author and food blogger presented the art and science of the fifth sense, Umami. She described how savory, meaty taste is key to survival, illustrating how animals are hardwired to seek out protein in the wild. Inspired to turn away from Big Pharma to the chemistry of healthy food, she presents an array of seaweed, mushroom, seafood and meat dishes (with many kid friendly options) on her NomNom Paleo website.
Justin Sonnenberg, author of The Good Gut, described the relationship of gut microbiota to all of health. For every one human cell, each of us has ten bacterial cells within us. We have a zoo of microbes inside ourselves and to achieve optimal health, we must carefully cultivate a healthy microbiome. Each of us is a true ecosystem of human and microbial cells. The bacteria living in our gut influence our immune function, metabolism, vitamin biosynthesis, hormone production, and more. Imbalance in the microbiome leads to impairment in these systems, and inflammation throughout the body. In one study, the transfer of microbes from lean donors to obese recipients (with no lifestyle or dietary interventions) led to enhanced insulin sensitivity and weight loss in the recipients. Sonnenburg explained how innovative techniques, such as fecal transfers, introduce healthy strains of bacteria to diseased populations and have dramatic therapeutic impact.
The common theme amongst presenters was clear: The most powerful drug is our diet. Eating a plant based diet, rich in a variety of fiber, including fermented foods, nuts and seeds, promotes a diversity of healthy gut flora. Exposure to dirt, pets and time spent in nature also enhance microbiome diversity. Detrimental to gut flora are low fiber diets, use of antibiotics and sanitizers, C-sections and lack of breast-feeding for infants. While probiotics can be beneficial, they provide only transient strains of bacteria to the gut. To cultivate healthy, balanced, resident flora, a diet rich in fresh, varied, fibrous plants is necessary.
Stephan Guyenet presented the idea that hard wired economic preferences lead humans to overeat. He outlined how obesity has skyrocketed in the past century, with readily available convenience/fast foods. To combat obesity, he proposes a public health movement to impose a tax on convenience/fast foods, thereby raising their cost and diminishing their perceived value.
Chris Masterjohn, PhD, outlined the body’s delicate balance of Vitamin D in the forms of calcidiol and calcitriol, with serum calcium. He proposes that parathyroid hormone, rather than vitamin D levels, may provide a more accurate picture of the dynamic state of bone health at any one point in time.
The event concluded with a panel discussion addressing questions from the audience. Most impressive was the team approach embraced by all; ego was checked outside the hall, and the presenters interacted with a desire to learn from one another, and, from the audience. What a refreshing approach to medicine; collaborative brainstorming, with respect for the experience and insight of all. Having been a student at UCSF, I observed this approach to be completely in league with the team based learning I had experienced here. While many medical symposiums can convey a dizzying array of facts and figures, leaving the audience impressed but stunned as to what to do with them all, this team presented all facts within a holistic, empowering framework, leaving us ready to take active steps for ourselves, and our community. Transformative results are possible with simple shifts directed at the core of our health, the microbiome.