Understanding Fear of Heights (and Falling)

You stand perfectly well on the sidewalk, but if you’re up on a box or ladder, you start to feel wobbly. Ever wonder why?   The fear of heights is a common one. Actually, fear of heights is slightly different than the true fear most people have – the fear of falling. The fear of falling is hard-wired. It’s one of the only fears you are born with (the other is the fear of loud noises).

When you’re working with clients in exercises that challenge balance, there will be the natural fear of falling. The best way to fix that fear is to practice with progressions that make people feel more secure.   Move from positions that have four points of balance (such as long stretch on the reformer) to a more challenging (less balanced) four points like standing splits on the reformer with both hands on the footbar. From there, create three points of contact, such as with standing splits with one hand reaching forward and the other on the footbar.

How else can you create three points of contact? For exercises like lunges on the reformer, simply push the forward knee into the footbar. That extra feedback into the shin will help you feel more secure until you feel balanced enough to have just two points of support (your feet). If you have a standing platform, use it to create a more stable base for the forward foot.

Three points of support is actually nothing novel. Look at rock climbers. They usually have three points (hand, hand, and foot; or foot, foot, and hand) attached at any time. By only letting one limb go at a time, they feel more grounded (or attached to the mountain, in this case).

But what about the fear of heights? What’s that about? And how does it affect a workout?

Fear of heights is linked both to fear of falling and to the disorientation you feel when things don’t look the same as you’re used to seeing them.

Let’s say you’re doing Going Up Front on the chair. The Wunda chair isn’t a terribly high surface upon which to be standing, but the world does look different from up there. If you’re 5’6” tall, you’re accustomed to seeing things from either your standing, seated, or supine height. You are hardly ever higher than that. Even doing a side plank on the mat and turning your head to look up can be disorienting (or it might throw you off balance if your vestibular system needs some work).

As a teacher, don’t discount people’s fears. But encourage them to face them with smart progressions. Know that neurologically, overcoming a fear will give your client a burst of dopamine that is a happy “brain drug” that helps create neuronal pathways that will help the memory of that accomplishment stick, making it easier to do the challenging balance exercise over time.

In health,

Mariska

Want to learn more about balance, fear of heights, and neuroscience? Check out Wobbly: A Balance Workshop on Pilates Anytime, come to one of our workshops, follow Pilates for MS on Facebook, or sign up for our newsletter!    

It’s 90 degrees… or as I like to say, “Kryptonite!”

It’s about two degrees shy of hell right now in Washington, D.C. Last year at this time, I swore I would be living in San Diego for the summer. That has not happened. That needs to happen. The other day, DC was the hottest city in the entire country!! Look!!

Hot. No bueno.

A hallmark symptom of multiple sclerosis is heat intolerance. I compare heat to kryptonite. I literally feel my strength draining away when it’s hot. Or humid. Or even worse, hot and humid (which is exactly what DC summers are all about.) Today, it is hard to walk to the corner. I’m having a little vertigo-induced nausea because apparently I live in a sauna. Again, I am rethinking my life choices…

Why am I in DC?

I stayed in D.C. because I got married.

Why did I get married?!

My husband – Lady Killer or Killer of Dreams?

Oh yeah, that. (He’s kind of adorable… and he cooks.)

Eight years ago, I was going to move to Seattle. Actually, that might not be the best choice because the Pacific Northwest has one of the highest incidences of multiple sclerosis in the world. (Then again, I already have it, so environmental risks be damned?)

I read once that the way they used to test you for MS was they would place you in a hot bath. If your symptoms got worse, they diagnosed you with MS. That actually seems a much kinder diagnostic tool than a spinal tap, though arguably less accurate. Your best bet is to have an MRI, since the only painful part of that is getting an injection of contrast dye. Unless you’re claustrophobic, of course.

Why is heat so bad for MS? In MS, there is inflammation around the brain or spinal cord, and that inflammation heats up (bad pun) as the body temperature rises, equaling a temporary worsening of symptoms. It happens if you have a fever, too. During the year that everyone got the flu (2012-13), I caught it from my young nephew (the 3-year-old bioterrorist). I could barely walk. Kind of like now, except that my rise in temperature is from my current distance from the sun (I’m thinking it’s 30, 40 miles at the most).

The good news is that when you cool back down, the MS symptoms subside. No lasting damage was done. It’s like you put on a lead apron or whatever-the-hell-Superman-did-to-overcome-kryptonite. Lead, right?

Why is Superman allergic to kryptonite if he’s from Krypton? Is this some sort of superhero autoimmunity??

Actually, there are several cooling devices specifically designed (or at least, marketed) for MS patients. I find them cumbersome if you actually want to work out, so for now, staying indoors will have to do.

For teachers who are reading this – if you’re thinking of cranking the AC to its highest for your MS clients, you should know that cold (really cold) also impairs nerve conduction. And it exacerbates spasticity.

Which leaves the only real option… San Diego.

In health,

Mariska

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“There’s No Point in Treating That. You’re Just Going to Get Worse.”

Over the years, I have had a lot of problems with my left foot/ankle – ankle pain and swelling, instability, and an annoyingly persistent case of plantar fasciitis. Fed up and frustrated, I started going to different doctors. I went to ankle specialists. I got orthotics, AFOs, dorsi-splints, functional electronic stimulation devices, and even went a neuro-orthopedics specialist at the University of Pennsylvania. I visited many a podiatrist in the D.C. area where I live. One doctor stood out above the rest (or shall I say, below?)

I went in and told him my ankle and foot have hurt for years. In our 5 minute visit, he said:

“It’s ironic that you got MS since you’re a Pilates teacher, don’tcha think?”

“Well, there’s definitely plantar fasciitis, but there’s really no point in treating that. Since you have MS, you’re just going to keep getting worse.”

“Here are some stretches you can do at home.”

He and I had already had a conversation about how I am a Pilates teacher, and I referred to all of my foot and ankle issues knowledgeably, using bone, muscle, and tendon anatomy that admittedly, impressed him. Yet, he sent me off with a “I won’t help you” and a couple of stretches that a high school trainer would know. These were the stretches. I can personally give you at least half a dozen ways to stretch the calves more effectively (or at least more creatively) than his handout.

At this point, I feel the need to point out a couple of things.

1. This man has a medical degree. From a university.

2. Being a Pilates teacher doesn’t mean you are immune to multiple sclerosis.

3. Multiple sclerosis doesn’t necessarily progress or “get worse.”

4. Plantar fasciitis is not a typical symptom of MS. It is caused by a strain in the ligament that supports the arch of the foot. Yes, this can be caused by poor walking mechanics, but I also could have had it because I am a part time ballet dancer (I’m not, but that’s not the point.)

5. I told him that I do calf stretches everyday.

6. The doctor in question is a jackass.

7. I had to pay for that appointment.

Sadly, I have to say that although he might be one of the most notable cases of dismissive doctors I’ve come across, he certainly isn’t the only one.

My point? If you have a medical condition or are just a person with a body that might get sick or broken or jacked up at some point in your life, you need to be your own advocate. You need to be able to know your body and walk out of an appointment able to say, “you might be a doctor, but you are wrong.” And then keep looking until you find someone who can help you.

How did the story end? A month or so later, I had an appointment with my neurologist. I asked him to give me an order for an ankle MRI because, I said, it’s not just foot drop; something’s wrong with my foot and ankle. The results? Tibiotalar joint effusion and moderately severe joint synovitis, as well as a type III accessory navicular limiting range of motion. In English? Chronic ankle swelling and an extra bone (genetic) that are both potential culprits in preventing my ankle from moving correctly.Which makes me right, and the doctor, still a jackass.

So, I’ll leave you with this “much better than his stretch” courtesy of the amazing Katy Bowman (one of my favorite bloggers). Roll up a towel or find a small half foam roller. Step onto it with the ball of your foot, and step the opposite leg forward (further forward = greater stretch). Keep your weight back in your heel of the same leg that is being stretched. Feel that stretch? Awesome, isn’t it? Maybe I should email this blog post to that doctor so he has a better stretch to pass along to the next person who is “only going to get worse.”

In health (and sometimes with attitude),

Mariska

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“You have MS”

They’re not exactly words that you anticipate hearing in your life (at least I didn’t). “You have MS,” she said. “But you should know that most of my patients aren’t in wheelchairs.”

I was diagnosed in 2002, officially by a neuro-ophthalmologist whose job it was to review my MRI and deliver the news. I was 27 years old. I had to wait over 2 months from the visit to the first doctor who thought I might have it til that visit. “You have MS.”

My diagnosing symptom was double vision. I started seeing two of everything when I looked left on the day I moved to Washington, D.C. (without a job… in a bad economy… after breaking up with an unreliable boyfriend whom I would later find out had never divorced his wife… but I digress). I went to an ophthalmologist who said she thought I had another autoimmune disease called myasthenia gravis. She asked if I had anything else that was weird.

“Well, my feet have been numb for about 6 months…”

“Why didn’t you tell me that when you came in?!?”

“Um, lady, because you’re an eye doctor.” 

She sent me for an MRI. I had to wait a month. I had to wait another month for an appointment with the neuro-ophthalmologist to tell me the results. In that time, I had a lot of time with Dr. Google. Brain tumor, Lou Gehrig’s disease, 6th cranial nerve palsy… But no. “You have MS.”

It was one of the best days of my life.

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In good health,

Mariska