Issue #378 – Wednesday, September 14, 2022
Pilates and One Healing Journey – Part I
by Marion Kessel, PMA® – NCPT and and Gail Feldman, Ph.D.
- Background [Marion]:
This case study originated when Dr. Feldman was referred to me by James Rice, M.D., of the Southwest Pain Interventional Clinic in Albuquerque, New Mexico (https://swipsnm.com/) where I currently live and teach Pilates (partly at his clinic). My relationship with Dr. Rice, one of mutual trust, has developed over many years, beginning when he came to my home studio with debilitating back pain that was hampering his ability to function professionally. Thankful for the help I was able to provide, he has since referred some of his patients to me. Gail Feldman was, and remains, one such person. As you will learn below, Gail is (now) an 80-year-old psychologist who has always been engaged in sports and other physical activities but who, over the years, incurred many injuries and developed serious movement and pain issues.
- Personal Beginnings [Gail]
I was an active kid who excelled in every sport. Since there were no organized girls’ sports in the ‘40s and ‘50s, I played baseball and touch-football with the boys after school. I moved to New Mexico in 1971 to pursue my passion for skiing, which I discovered in college.
I am no stranger to injury. In my forties and fifties, while extreme skiing, I broke my left shoulder in five places, broke several ribs and injured my neck and lower back; it took a year of PT (Physical Therapy) and swimming to rehabilitate. Later, I broke my right shoulder in two places and suffered a head injury. In 2003, another right shoulder injury required surgery to repair the rotator cuff and reattach the biceps tendon. But I always healed and returned to normal activity.
- Emerging Problems [Gail]
In July of 2020, I began having right hip and lower back pain. My orthopedist diagnosed arthritis and gave injections with no reduction of pain; he referred me for four sessions of PT. By the beginning of September 2020, I could only walk short distances unassisted. Over the next 8 months, I saw three chiropractors regularly and a D.O.M. [Doctor of Oriental Medicine] for acupuncture.
In November 2020, I underwent an MRI, and the results were shocking — I couldn’t see how healing without surgery was possible. Here are those “shocking details” (in appropriately technical language for those readers with a medical background) that are very interesting in the context of what our Pilates session ultimately achieved:
The MRI showed the patient to have disc bulges with facet arthropathy at L2-L3, with mild-to-moderate central foraminal stenosis at the L3-L4 level. At L4-L5 there was severe facet arthropathy with a left-sided synovial cyst and also associated degenerative disc changes and grade 1 to 2 anterolisthesis at L4-L5 resulting in moderately severe to severe ventral stenosis with thecal effacement. There was moderate bilateral foraminal stenosis at this level. At L5-S1 there was also degenerative changes of the discs and facet joints, and prominent moderate bilateral foraminal stenoses were noted at this level as well.
Among his other medical observations, I was diagnosed by Dr. Rice as having chronic pain syndrome with spinal stenosis.
- Escalating Problems [Gail]
From the Fall of 2020 through the next year, I became less able to walk alone. I finally gave in and used a walker daily along with a wheelchair through airports on trips to family. The idea of being impaired and in chronic pain was truly depressing, and the idea of back surgery (recommended by a neurosurgeon) was frightening. Unwilling to face surgery, I continued doing back exercises from Pain Free by Pete Egoscue. But that didn’t seem to help.
In January of 2021, I found a lump in my left breast and was diagnosed with breast cancer. February was taken up with biopsies, tests, and visits to surgeons and oncologists, to which I had to be driven and helped to walk from one clinic to the next.
Healing from the breast surgery took much longer and was more painful than I expected.
At that point (March 2021), after I had worked with a massage specialist and continued with acupuncture, I consulted with Dr. Rice. Over the next four months, he administered three targeted epidural steroid injections. But I had no relief from the back pain and sciatica down both legs. I worked with a new chiropractor, again with no relief.
Dr. Rice then referred me to Marion Kessel and my first session with her was on June 7(2021), then 2-3 times per week thereafter.
- Overall Perspective/Goals [Marion]
Based on decades of practice and experience, some involving my own recuperation (“Pilates: The Past in the Present (and the Future)”. Pilates Intel, Issue #353 – Wednesday, December 1, 2021), [PPI1] and what I’ve referred to in many workshops as Marion’s Method Pilates and Separation-and-Integration, my hope was to give Gail relief through a slow, careful introduction to Pilates. This introduction involved small, internally-focused movements initially aimed at the presenting problem, viz., her lower back pain. However, in order to alleviate that – and consistent with my basic, whole-body approach – we had to strengthen her core to support her lower back, return mobility and strength to her ankles and feet, and correct her alignment. That, in turn, involved stabilizing her shoulders while easing and enhancing her neck and head movement. And correct, lateral breathing (including breathing through the pain) was, and is, essential to all these steps. Such small-scale work is sometimes referred to as ‘pre-Pilates’. My initial sense of such work originated during my recovery from PMR (Polymyalgia-Rheumatica) but was deepened and verified through exposure to Eve Gentry’s approach and ideas.
When we first met, Gail’s movement and gait were severely compromised by her pain and she had to rely on a walker for basic balance and mobility. Understandably too, because of her pain, fear of major back surgery, and the absence of long-term relief through medical interventions, fear of still more pain was the over-riding emotion. Consequently, and again understandably, despite Gail’s knowledge of movement through long-time sports engagement and her obvious, intrinsic ‘body sense’, patience and trust in me and the slow, small, seemingly minor pre-Pilates work that we were attempting only developed slowly.
Of course, patience/persistence goes both ways. For example, given severe restriction and pain in her neck and shoulder area (partly as a result of sports injuries and surgeries), Gail was reluctant to even try ‘profile-on-a-coin’ (head movement) and ‘puppet-arms’, insisting that her doctors and physiotherapists had ruled out any such movement. But I gently, patiently, and repeatedly suggested that she try such movement … because it is possible to develop pain-free flexibility (even after multiple injuries and surgeries)!
We will pick up this discussion next week in Part 2.
Marion Kessel PMA® – NCPT has been a Pilates practitioner for 30+ years. In her ‘other life’, drawing on early, firm foundations in music, stage-craft, theatre and dance, she has created documentaries on the performing arts and directed multiple cameras for live screenings of opera performances. After living in several cities on several continents (e.g. Minneapolis, Edmonton, The Hague, Houston and New York), Marion and her husband now find themselves in Albuquerque, New Mexico.