When I was 37 I had so many exciting changes in my life. I quit my last independent contracting job in the city to finally work full time on my own Physical Therapy practice. My partner and I were in that blissful and unmooring phase of our new relationship- and we split time between his beautiful apartment in the city and my place in sleepy Marin. We had just adopted a rescue pup we were both enamored with.
And yet, for the first time in my life, I could not sit still. When I would try to sit for my morning meditation, I would not be able to focus. When I tried to draw deeper breaths, it felt claustrophobic. and choppy.
I chalked these symptoms up to anxiety from all of the change in my life. I kept thinking of that stress scale- moving divorce, death. A new puppy, new relationship, new business had to be up there too? Outside of a couple of brief episodes during athletic events, I had never really experienced anxiety. I doubled down on my meditation practice and yoga postures for de-escalating the sympathetic nervous system. I cut down on coffee and other stimulating foods.
One Saturday, during this time, my good friend Georgia and I went with Andy and one of his friends to ride Tamarancho mountain bike trail, right near our place. It was a goal of ours for the year, and we had been riding pretty consistently and working on our fitness to do it.
On the climb, I lagged behind the others, feeling winded and low on energy. I was so short of breath, I couldn’t draw deep breaths. We all thought this was anxiety about the more technical switchbacks and roots. When we got to the top of the first set of switchbacks, I was shaking and couldn’t draw deep breaths. I felt so bone weary, I couldn’t imagine going on.
We decided I should go back, and Andy walked back with me, pushing our bikes until we got back to the trailhead and could ride the roads home.
This prompted a trip to my doctor. Upon meeting with me, she took my vitals, and my heart rate was at 125 (!) I was just sitting in her office and I hadn’t exerted myself in anyway. I shudder to think what my heart rate was at on that trail climb. We realized, in addition to my rapid heart rate, I had lost quite a bit of weight (my weight is normally super steady) and as she started to click on her computer to request additional diagnostics, I was floored.
I was so sure, based on how I felt, that I was suffering from some mild anxiety.
As most of you know, I ended up getting diagnosed with a form of hyperthyroidism called Grave’s Disease. (Shout out, by the way, to the wonderful doc at Kaiser for helping me get diagnosed so quickly- I’ve heard folks can languish for years without a proper diagnosis). I got set up with a great endocrinologist, and the road to healing commenced. The story around my healing will be for another time.
This personal experience is relative to what I see in the clinic all of the time- our symptoms can sometimes be helpful in our understanding of what is going on in our bodies- but there are a couple ways we are disadvantaged to have insight to our physical challenges based on our symptoms.
1) We are too close to the experience and can’t develop objectivity (and many of us don’t have MDs. And even if we do, we shouldn’t be practicing medicine on ourselves!)
I see this all of the time in the clinic. Like in my case, I thought that my tension and anxious feeling was the issue. I didn’t have all of the objective picture of my heart rate and weight loss. I am also not an endocrinologist or GP- I don’t have the whole picture to make diagnostic decisions. Even in orthopedic physical therapy care, I would never attempt to “treat” myself. I would not have enough objectivity or distance to be able to see my whole clinical presentation clearly.
I also hear a lot when I ask if someone has had physical therapy, “oh I did my own rehab”. I always have to chuckle. Please don’t “do your own rehab”. Please. That’s like me doing my own surgery- not good.
2) We are often disconnected from certain physical sensations
Sensory experiences of the physical body change like the weather. You have an ear itch. Then your right butt falls asleep. Then you have a weird pain in your stomach. A way to notice this is to practice a body scan (I love this one by John Kabat Zinn), and watch how symptoms shift and change and swirl like thoughts. All of this usually goes on without you realize it. You scratch. You shift your weight and blood flows back to your hip.
Our musculoskeletal system is not the only system that creates sensation. Sensation also arises from emotion. Have you felt butterflies in your stomach with nerves or anxiety? Have you felt your heart ache after a breakup? Grief, joy, love, fear- these emotions illicit felt sensations in the body. Body scan practices are also helpful for knowing how emotional content manifests in your sensory experience.
In addition to emotions, our viscera (our hollow organs- think intestines, liver, stomach) can refer pain in unusual ways. I recall treating someone with self-diagnosed “rib pain” that was definitely not mechanical (not reproducible with palpation, movement). I referred her back to her MD and further workup revealed gall bladder issues, such that she required surgery.
3) We can’t infer meaning from sensory experiences
This goes back to #1 and is really and I mean really tough for our brains. We are masters of making sense of things. We justify experiences so that we may understand them. I often think of Greek mythology when I think of this- we don’ know how volcanoes work, so we create a myth about an angry, fire breathing deity living below the earth to explain them.
When we have a sensory experience, especially when it is an unpleasant one, there is a tendency to explain it. It is connected to this old fracture, it is connected to my emotional state- whatever. The truth is- we actually don’t know. We usually need an objective perspective- outside help from a trusted source to help us make meaning.
What our work is when we notice physical sensations, is to stay in the middle path of not pushing sensations away (not sweeping them under the rug), but also not clinging to them through narratives that may or may not be correct. This inhibits our learning and healing and makes us less available for getting to the heart and truth of the situation.
When you have a physical sensation, feel it, experience it and acknowledge it. It is not the whole of the picture, and it is also not for nothing.
In addition to noticing symptoms by checking in with the felt sense of the body daily (such as via a body scan), and to the work of feeling and not developing stories, I would add a third arm of the work- noticing current level of function.
Noticing function, unlike symptoms, is measurable. It is objective and also tangible. As I mentioned, sensation is fleeting. It changes day to day like the surf. It is related to emotional states, dependent on literally all of the systems in our body, including our nervous system.
Whenever I see folks in the clinic who are working with pain, I always instruct them in working with function, rather than sensation.
Function is also optimistic- it is noticing what you can do. A list when someone is recovering from an orthopedic surgery might look like this:
- I can stand for 25 minutes
- I can walk for 10 minutes on flat surfaces
- I can get into an out of a chair 8 times in 30 seconds
- I can stand on my surgical side (single leg balance) for 10 seconds
You can start today and make a list of your current function. In my story, my function was precipitously declining. I was able to do less and less. Despite training, I was losing leg strength at a super fast rate. In retrospect, these were all red flags for me to get my booty to the doc.
If sensation changes like the surf, function is more like climate change. It is coming, if we don’t work on it. Strong action taken now will make good outcomes in our future. Function is slower to change, and working on it will create better results.
You can check in with your functional status (current levels) and set goals monthly, quarterly, annually- whatever feels good for you. If you want to be a super overachiever (you would wouldn’t you?!), you can work with building sensory awareness through meditation such as body scanning, AND concurrently work on functional status check ins. If you have functional goals that elude you, consult your physical therapist to see how you can make progress toward your goal(s).
In summary, and since this was such a looong post:
1) Notice sensations in their raw form- without assigning a narrative to them
2) Practicing sensing into your body, quietly and on a daily basis can help you develop more intimacy with what your body typically feels
3) Focus on function when checking in with yourself
Happy sensing and moving!