The team teaching was most valuable for me. We could hear a correction, a different explanation or perspective instantaneously. That was great. There was a really good amount of science and its accompanying technical talk. I really, really appreciated that. Wish we had more hours together to get to play, feel and absorb!
Student, Chicago, IL
Everything in this class was valuable. It was all new to me, and I’ll be able to use it. I like the interplay between the two instructors. Lauren has a deep, deep knowledge of this work and it seems like all the related areas.
Duane, Palatine, IL
I’d like to begin practicing with kiddos of all ages. This class helped me by just familiarizing myself with their being-ness, their bodies. The class helped educate me by filling in the map regarding youth-anatomy, pregnancy and birth. Super rich and information course. I couldn’t hope for better. You’re a deep inspiration. Thank you for your guidance and wisdom!
Audrey S., Wilson, WY
I feel good about myself in taking on this course and working through any struggles with understanding how to apply this work. I am growing as a person in how I see and communicate with people in my life. I feel I have an improved vision of the world around me. I am so happy to be a student of yours in this program! This is the start of a lifetime of learning about craniosacral therapy.
Eric T., Poulsbo
The Core Series is forcing me to slow down and remember that a) I don’t have to know/do it all, whether it’s work I am doing in a session or when I am learning/reading on my own. And b) So many other things. :-) I think the biggest impact (so far — that will likely shift a million times) is how I see the importance of spaciousness in all ways: my work, my inner and outer worlds and relationships.
I love the dance that Lauren and Buela do with teaching. So thank you for that — and your kind patience as we all try to figure this out.
Angela C, Snohomish, WA
A compilation of info, as we know it, about this virus. Sources listed below.
R0 = 2-3
The “R-naught” is description of how spreadable a disease is; how virulent. For example, typical influenza has an R0 of just over 1, meaning that the disease spreads at a one-to-one rate. COVID 19’s R0 is between 2-3. This means that one person can spread it to 2-3 people; who then can spread it to 2-3 — effectively resulting in 9 people infected. This is the ‘exponential’ aspect of COVID that’s so different from other viruses.
We’re all aware that’s the distance we need to stand to create ‘social distancing.’ That’s because we distribute aerosols by breathing/speaking normally. There’s still clarity needed about how much viral load typical aerosols carry (and therefore the risk of exposure). We do know that droplets carry enough viral load to be a risk. Droplets exit the lungs with more vigorous breathing, such as singing, shouting, panting during heavy exercise, and certainly with coughing and sneezing. Covering our mouths becomes a simple strategy.
The estimate of how long droplets stay in the air before landing on a surface. This measurement assumes still air flow and enclosed spaces. We don’t have clarity about how those factors may reduce the time line.
General agreement of how long this relatively fragile virus can remain on surfaces (between hosts). By comparison, the super-hardy tuberculosis virus can last up to 6 months on surfaces as long as it’s not exposed to sunlight. (That’s why in early days of TB, people were gathered in treatment centers called ‘solariums.’)
2+ / 5 / 11.5 / 14 days
Incubation period between exposure and infection — realizing that some people show few or now symptoms. Two-plus days is a figure from very recent studies in China. Five days is the more agreed upon figure of median incubation period, meaning how long it takes for most people who get the disease. By eleven and a half days after exposure, most (99%) of the people who show symptoms have them. Fourteen days is the conservative, public health margin for all of us to keep to in case of exposure.
Day 1 = onset of symptoms
With the onset of symptoms, another clock begins. This one is important, because we’re learning that people are most infectious at the beginning of symptoms. While some pre-symptomatic contagion has been shown, later studies reveal that this pre-sypmtomatic window is less risky than first thought. What remains is that some people can be ‘silent spreaders’ — spreading the disease unknowingly — because their own symptoms are so mild. Why social distancing is a dance for all of us!
General span of time from infection to ‘shedding’ the virus — to being through the tunnel. People are developing antibodies — hooray! This is important for three reasons:
• There’s a high likelihood that people will have extended immunity, and so can come back into the work force, potentially in higher risk situations (volunteering, drivers, check out clerks, etc.), and
• Scientists are hot on the trail of vaccines, since this virus appears to be one that mutates slowly. We can be better prepared and protected the next time it comes around, and
• More immediately, clinicians are using antibodies donated from those who have shed the virus as a treatment: injecting antibody rich plasma into severely ill patients giving their immune systems a boost.
This situation keeps unfolding. Do want you need to do to take care of yourself, including the simple precautions of hand washing, social distancing, don’t touch your face. And all the things you know to do to take positive care: sleep, nutrition, exercise, heart connections with beauty and nature.
With the current spaciousness in my schedule, I decided to do something I’ve been wanting to do for years: learn more about the carpal bones! For years, knowing the tarsals has helped my work be more precise and effective. I’m excited to see where this takes me with clients.
How I learned:
Richard has been an obliging client, who conveniently (for me!) has a minor wrist injury from more gardening than usual. Slow, methodical palpation while looking at our plastic forearm model was super helpful. Usually, with clients I feel obliged to stay focused on their treatment. Knowing I could take my time palpating and noodling around was such a treat. I had time to allow my fingers and my mental anatomy atlas meet each other. Then there’s the coloring, mnemonics and some youtube viewing — see links below. Here are some details and insights from my study.
Most mammals have the same number of bones in their appendages, and the upper and lower appendages mirror each other. Distal to the ball-and-socket joint at the girdle, each appendage has:
• one long bone (humerus/femur), followed by a
• two slender bones (radius-ulna/tibia-fibula), followed by
• a cluster of small, rounded bones (carpals/tarsals), then
• five shorter ‘long’ bones (metacarpals/metatarsals – “meta” means after or beyond), and lastly,
• a series of phalanges (fingers/toes).
Like the tarsals, the carpal bones arrange themselves in 2 ways: horizontally across the wrist in two rows, and vertically (roughly) in 2 clusters, relating to either the radius or ulna. In the foot, those separations coordinate with the medial and lateral arches; they relate to the thenar and hypo thenar pads in the hand.
There are 8 carpal bones, here listed in their horizontal row (with the forearm bone or metacarpal noted):
• lunate (ulna); beyond that the triquetrum, pisiform (5th MC), hamate (4th MC)
• scaphoid (radius); beyond that the capitate (3rd MC), trapezoid (2nd MC), trapezium (1st MC)
The joints include elliptical joints between the forearm and first row of carpals (wrist flexion/extension), and sliding joints (among each each and with the metacarpals). Our one and only, world famous saddle joint of the thumb — between the trapezium and the 1st metacarpal — is the one that makes human hand capacity so unique!
Starting from the ulnar side, when I palpate my own wrist on the anterior side I notice:
• A little gap between the end of the ulna and the lunate holds a disc to cushion strong impacts.
• Just distal to that gap, is the prominent pisiform, at the ‘heel’ of the hand.
• Rounding around the pisiform toward the midline of the wrist, you’ll feel another clear edge. That’s the “hook” of the hamate — really that’s its name. Ligaments that create the carpal tunnel attach to this hook.
• The capitate and trapezoid are easiest to feel posteriorly, same with scaphoid.
• Once you’re on the radial side, the trapezium has a projection, but it’s called a ‘tubercle’ — a distinct edge when you roll toward midline.
• The scaphoid also has a small tubercle. The two tubercles are the attachment sites for the other end of the ligaments that form the carpal tunnel.
Palpation = Treatment
Gliding these bones between themselves feels really good!
With the client’s palm facing me, I take my thumb on one side, and index and middle fingers on the back of the wrist. I locate a single carpal bone — for example, one on the hamate, one on the capitate. Using an anatomy image is helpful with this level of detail.
Then glide them gently in opposite directions. When you feel a motion barrier, gently meet it and then sustain your engagement. Give the joint time to respond and release. Remember that the overall range of most of these joints is quite small. Don’t look for large movements, just little bits of sliding past each other.
Anchoring the information — whatever helps!
Youtube links that might be fun:
• Ninja Nerd Science: short discussion of hand anatomy; this guy’s great!
• Armando Hasudungan: cartoon drawn discussion of wrist and hand
• Physiotherapy is Rehabulous: online lecture with charts and diagrams
Mnemonics — with the capital letter of each word/bone matching.
• Some Lovers Try Positions That They Can’t Handle
Scaphoid — Lunate — Triquetrum — Pisiform — Trapezium — Trapezoid — Capitate — Hamate
• Never Lower Tilly’s Pants, Grandmother Might Come Home
Navicular (old name for scaphoid) — Lunate — Triquetrum — Pisiform, — Greater multiform (old name trapezium) — Multiform (old name trapezoid) — Capitate — Hamate
From the Anatomy Coloring Book and Netter’s Anatomy Coloring Book. (If you’d like some pdf’s of these pages, let me know.)
Likely you’ve come across this story. These days, it’s been on my mind as I meet the unknowns of the disruption of COVID-19.
The Two Wolves
An old Cherokee was teaching his grandchildren about life. He said, “A battle is raging inside me…it is a terrible fight between two wolves. One wolf represents fear, anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority and ego. The other stands for joy, peace, love, hope, sharing, serenity, humility, kindness, benevolence, friendship, empathy, generosity, truth, compassion and faith.
The old man looked at the children with a firm stare. “This same fight is going on inside every other person, too.”
They thought about it for a minute, and then one child asked his grandfather, “Which wolf will win?”
The old Cherokee replied, “The one you feed.” — from “Transforming Lives Through Resilience Education”
As the waves of fear, worry, confusion or denial have risen in me, I’ve relied on my connection with my body and with spirit to breathe through those moments. Walking, breathing, feeling my body’s strength, sleeping when tired, eating when hungry. The unstructured time has allowed me to reconnect with my body in a deep way, resourcing myself. As Mary Oliver writes, “You only have to let the soft animal of your body love what it loves.”
I’m so grateful for my years as a manual therapist. I’ve learned how this wonderful body coordinates health, how to ground into my immediate physical experience, how to understand stress signals as signs of a body getting ready to meet the challenge — a body attuned to health. All of this helps me meet the various unknowns of this pandemic. Most of the time.
At other times, my fear rises so quickly that it’s like running after a wagon broken free. My sense of self is just behind my body, heart and mouth — panicked– careening down a steep bumpy hill. All spikey adrenaline and grasping. These moments call for a different kind of center, an ‘after the fact’ kind of center. Can I embrace myself and acknowledge that I’m doing my best, even as I flail about – even hurting those nearby? It’s times like these that I sense the deeper wisdom in this story: yes, we grow the parts of us we feed. And sometimes, we need to feed fiercely.
That’s why I love this picture — the fierceness reminds me that the fight is worth it, I’m worth it. Together, we can protect what is most important to us. We can orient our choices and commitments to deepen a sense of connection, health and justice. This is a terrible time, a trying time — and perhaps one where we can come out the other side more connected, more centered. We’re all in it together.
Thanks to Bonnie Wong, DO who sent out this simple graph. I’ve referred to it more than once in the last month, much to my relief. It’s also helped with clients who aren’t sure what’s happening for them. While we’re not doctors (nor can we diagnose — especially these days), we can help people clarify what they are experiencing and what to do next.
What to do next
The first step: if you’re not feeling well, stay home! Rest, recuperate and keep potential germs localized by washing hands, not touching your face…You know the drill.
Next step: if your symptoms worsen (or your anxiety spikes), contact your primary care provider. Review your symptoms with them. If you don’t have an established PCP, contact your insurance carrier. The number is on the back of your card. By this point, most carriers have established tele-health options, so they will connect you with a nurse or doctor who can screen your condition.
Next step: Along with any instructions they give you, remember to take care of yourself. Sleep, diet, movement, and tending your heart and mind. All of these can support your body as it meets whatever condition you have.
Do the Five
The World Health Organization has a simple campaign to help stop the spread of COVID-19 (and many other diseases): Do the Five! I imagine you’ve seen the PSA icon on Google:
1 Hands — wash them often
2 Elbow — cough into it
3 Face — don’t touch it
4 Space — keep safe distance
5 Home — stay if you can
I love the simplicity.
Practicing the Five
Here’s what I’m learning as I practice these 5 steps.
• Changing habits is as difficult as ever, and once I’ve washed my hands multiple times a day, I absolutely need to put lotion on them! Protecting the skin envelope feels important just now.
• Since I’m coughing into my elbow, I’m not so keen on elbow bumping as a greeting. Instead, I’ve been toe tapping or hip bumping, even back wiggling–but only with close friends!
• My left brain says I’m probably not touching my face any more than usual, but wow! I had no idea how often I do in fact touch my “T-zone”: eyes, nose, mouth. So, I’m contenting myself to touch under chin, side of my head. For expert inspiration on this, I’ve been re-watching RuPaul’s Drag Race! Learning to vogue in my spare time. ;-p
• Keeping safe distance on the whole hasn’t felt like such a change in some ways. As an introvert, it feels like society has taken a big shift toward my way of being. (Odd though.) My extrovert family and friends are going stir crazy, desperate for activity and interchange. Where I do feel this change keenly: no hugs or touching, no clients. It’s so strange to be someone who touches for a living, and then have that suspended.
• Home stay has been such a gift, not the least because we are lucky to have a home that suits us — a blessing in so many ways! Richard has been tending the garden as spring begins to really present itself; he’s been cleaning and fixing and puttering. I’ve been doing projects too: tidying, purging, spring cleaning comes early!
And Another Five
Steps to help us when anxiety or fear arises:
- Look around you.
- Find five things you can see,
- four things you can touch,
- three things you can hear,
- two things you can smell, and
- one thing you can taste.
Such a simple exercise — but what a wonderful way of coming into the present moment, with all our senses. The only thing I might add is to take a breath for each one of these senses. With this, we’re able to move from a thought-based orientation to a body-based orientation. Staying in the present moment and connected to our environment is a simple first step.
Take good care of yourself — with one 5 and another!
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