Learning to walk was a trial and error affair. I fell down a lot, watched what the grown-ups did, and gradually learned to stumble less: sort of the way I learned to process my emotions. But what if the grown-ups I learned from were doing it wrong?
Learning to Walk
The physical therapist watched with concern as I walked up and down the hallway. She said that my right leg was doing most of the work and my left hip was just along for the ride.
I said that was how I had always walked.
She said that it might well be, but it could lead to problems down the road.
I confessed that I was self-taught.
We both laughed. I realized that her job was to teach grown-ups the right way to do things they’d been doing wrong all their lives.
She gave me an exercise to strengthen my left quadriceps so that I could learn to walk correctly.
Healing the Body, Not the Behavior
Because the fussy type of fracture I had sustained through a stumble, my primary care physician had referred me to a podiatrist instead of a sports therapist to oversee the bone’s mending. I didn’t think about the implication this had for regaining my mobility.
The podiatrist’s specialty was to restore the foot. The sports therapist’s specialty was to restore how I used it.
As the physical therapist I was referred to after the bone had healed intently scrutinized my gait, I thought about how this echoed depression treatment.
Keeping weight off the foot was sufficient to heal the bone. Taking an antidepressant was sufficient to regulate the brain’s chemical imbalance.
But I’d sustained my initial fracture by stumbling with my feet. And I’d sustained my initial depression by stumbling with my brain.
By analyzing how I used my foot or brain, the therapist’s job was to show me how to stumble less.
Learning Through Treats
At my age, it’s a little embarrassing to admit that in order for me to learn something I still need treats.
In behavioral science (B.S. for short), the acknowledged path to learning a new habit is:
Trigger.
Response.
Reward.
The physical therapist addressed my foot’s swelling at our first appointment by giving me a Manual Lymph Drainage massage. This meant gently stroking the sides and back of the knee and gliding her fingertips over the calf in an upward direction, finally moving down to the ankle in gentle circles.
I noted that it would be easy to remember to do this at home because it felt good.
Trigger: Waking up in the morning.
Response: Doing the Manual Lymph Drainage massage.
Reward: It felt good.
Learning Through Tricks
The two exercises, soleus stretch on the wall (for ankle, calf, and thigh stretches) and standing heel raises (for strengthening ankle and calf) weren’t painful, but weren’t naturally pleasant.
I’d have to trick myself to do them by linking them to the preexisting trigger. My morning sit-ups aren’t pleasant either, but I’ve managed to stick with them long enough to enjoy the deferred gratification of a flatter, firmer stomach. I could anticipate the deferred reward of the stretching and lifting would be walking with greater ease.
I enjoy my walks.
Learning Through Fun
At my second visit, we dispensed with my need for treats or tricks by tapping into one of my passions.
Instead of exercising my muscles, we began exercising my brain!
Like the exercises to move from depression to well-being, the instructions were simple, but the work wasn’t easy.
To do single leg balance – foot behind, all I had to do was stand with my arms at my side and lift my uninjured right foot behind me.
My calf and ankle muscles began shooting confusing instructions to my brain:
Pull to the left, no, to the right, too far, no left, now forward, no backward!
I couldn’t keep my right foot aloft for more than a few seconds.
The therapist reassured me that this was a little tricky at first, but I loved this challenge from the moment the muscle twitches began.
Mindfulness of the Body
A popular (simple but not easy) method for training mindfulness of the body is to begin at the top of the head or tips of the toes and slowly direct attention upward or downward until the entire body is scanned.
A challenge I’ve always had with the body scan is that while I could imagine where, say, my spleen was located, I could never detect how it talked to my brain.
The nerve endings and muscles in my left foot and lower leg chattered in rapid-fire conversation about how to keep me from stumbling, and I could hear it loud and clear. This was a response I was happy to develop a number of triggers for (any time I took a break from writing, went to the bathroom, stood in a line). The reward was the opportunity to practice training my brain with some tangible real-time biofeedback!
We also added seated ankle alphabet: slowly tracing the letters of the alphabet with the toe of the recovering foot. I realize that this might not sound as fun to you as it did to me, but, as a practical way to demonstrate how to use one’s attention to retrain the brain, this was exciting stuff.
Intrinsically Rewarding Well-Being Exercise
I told the therapist how well these exercises corollated with my depression to well-being work and she confessed that she’d never been able to meditate.
I offered her a mental well-being habit with a variable trigger and a guaranteed reward that I love to do.
Trigger: Notice when you experience a moment of pleasure, like I did when I discovered how much fun I could have with the balancing exercise.
Response: Pay full attention to the pleasure for as long as it lasts or your attention is called to something else.
Reward: Paying attention to pleasure is its own reward no matter what the pleasure is: your first sip of coffee in the morning, feeling warmth of sunshine on your face, smell of fresh-baked bread, sight of a close friend arriving from the airport to pay you a visit, sound of a timer reminding you that it’s time to take a break.
Learning to Motivate
In the time that I spent in the waiting room before sessions, I observed people who faced much more debilitating mobility challenges than I did, and whose recovery would involve working through pain.
I asked the physical therapist a question about a problem we had in common. Like the physical therapy exercises, the mental well-being exercises only work if someone does them.
She told me that motivation was a large part of her training. She used motivational interviewing to help patients discover the discrepancy between the thing they wanted to do, and their current physical status or behavior.
For example, if I had been resistant to the Manual Lymphatic Drainage massage, we might have explored how my swollen foot made it impossible for me to wear my shoe properly. This threw off my gait and caused blisters, which hampered my healing and made walking painful.
If I had resisted the balance exercises, she might have taken the bad cop approach and pointed out poor balance increased my chances of re-injuring my foot and landing me back on crutches. On the good cop side, the weather was getting nicer and I wanted to get back to hiking my favorite forest and mountain trails. I needed to improve my balance to climb hills and negotiate rocky terrain.
She said that if the patient was motivated to achieve their goal, the physical therapist was there to offer them techniques that they could try.
If the patient wasn’t willing, all she could do was tell them to come back when they were ready.
Whether exercising to recover from a fractured foot or depression, learning to stumble less required some effort. As she put it, “Magic is in short supply around here.”
Ten Minute Exercise
One of my favorite lessons on learning to stumble less is Portia Nelson’s autobiography. Don’t worry. You can read it in less than ten minutes.
Autobiography in Five Chapters
by Portia Nelson
I
I walk down the street.
There is a deep hole in the sidewalk
I fall in.
I am lost…
I am hopeless.
It isn’t my fault.
It takes forever to find a way out.
II
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I’m in the same place.
But it isn’t my fault.
It still takes a long time to get out.
III
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in…it’s a habit
My eyes are open; I know where I am;
It is my fault.
I get out immediately.
IV
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.
V
I walk down another street.
