Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians

How do I find a good massage therapist?

Most stock images of massage feature tropical flowers, perfectly white towels, and beautiful young women with flawless makeup.  This in fact has never been my experience and I'm 100% ok with that. I'd love for massage establishments to STOP using gendered stereotypical images like this.

Most stock images of massage feature tropical flowers, perfectly white towels, and beautiful young women with flawless makeup.  This in fact has never been my experience and I'm 100% ok with that. I'd love for massage establishments to STOP using gendered stereotypical images like this.

My friends and colleagues often ask me questions, and one of the most common is "how do I find a good massage therapist in my city/area?"  It's a great question, and not a simple answer.  

First of all, what makes a "good" massage for you, i.e. what conditions must be present for you to feel relaxed and supported?  What type of pressure do you like? (Soft tissue, energetic work, craniosacral, deep tissue, structural integration, etc.)  A "good" massage depends on your body, your issues, your likes and dislikes, and a host of other factors, so there is no one bodyworker that is perfect for everyone!  Just because you loved one particularly practitioner or session does not mean that your friend will, and that's ok.

What's going on in your body that is spurring you to seek a massage?  Are you overly stressed, in pain, working with a chronic pain or muscle issue, recuperating from a surgery, pregnant, dealing with chemotherapy, etc? 

This is a way more accurate image of my massage experiences- charts, props in the room, clothing on, etc.  I've never had a massage where tropical flowers seemed with an appropriate hair accessory.

This is a way more accurate image of my massage experiences- charts, props in the room, clothing on, etc.  I've never had a massage where tropical flowers seemed with an appropriate hair accessory.

What do you want to accomplish in your session- is this a one time session or are you hoping for multiple sessions?  This can help your bodyworker best serve you, but also help you choose a practitioner as well.  

One of the big questions I struggle with as a movement teacher is are you treating the symptom of a movement based problem, or are you treating the problem itself? So let's say that you have knee pain- you can get a massage that focuses on hips, quadriceps, and shins.  This can be totally beneficial, but what caused the knee pain to begin with?  Was it your shoes? Your gait? Do you want a session that will help clarify what the problem is, i.e. should you see someone who is a physical therapist, a bodyworker who does muscle testing or movement assessment, etc.

Next question is to look beyond chain massage facilities-there are some great therapists at chains, but many times, recent program graduates with less experience are working at such places.  When reading someone's biography, look at how many years of experience they have to begin with.  What sort of the training do they have?  Most states have a comprehensive 750-1000 hour massage certification, but beyond that, many people will seek continuing education, other certifications, or specializations. What sort of populations does this person serve or aim to serve? (older clients, those with special issues, etc.)  Do they have anything in their biography that indicates a focus on your specific issues, pains, etc.? If they don't say "focus on performing artists" in their biography, it doesn't mean that they can't be of help, but it's something to also consider.  Some of my favorite massages (and personal training sessions) have been from people who used to play the violin, viola, or cello, and who very much can visualize what my issues are just from playing the instrument.  

With all this begin said, I personally like deep tissue work, as someone who is not petite and with a lot of muscle mass.  This is not good for everyone, however!  I also like bodyworkers who understand human movement more in depth, and who maybe have training in assessment strategies, such as the work of Grey Cook and the SFMA/FMS.  I also have had some really interesting success with NKT and P-DTR practitioners.  If you're working with a chronic issue that is undiagnosed (and you're not being treated for), I'd highly recommend seeing a medical professional, and working with a good physical therapist who does both manual therapy, movement screening, and correctives.  Next up- unraveling the acronyms of movement and manual therapy!

Proprioception, Kinesthesia, and Change

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Let’s look at two words that are often used interchangeably but mean different things: proprioception and kinesthesia. According to the American Heritage Science Dictionary, proprioception is “The unconscious perception of movement and spatial orientation arising from stimuli within the body.” In other words, it’s the awareness of body position and location.

Kinesthesia is the “Sense perception of movement, the muscular sense,” meaning an awareness of how movement is performed. Proprioception is the result of sensory input throughout the body (skin, fascia, muscle, joint receptors), which then sends feedback to the spinal cord and brain.

Kinesthesia, however, is more behavioral in origin and your body is more actively involved in assessing movement patterns and making adjustments. In yoga and other movement disciplines, we need both our proprioceptive sense and kinesthetic abilities to execute tasks. In addition, the brain exhibitsneuroplasticity, meaning that changes in nerves and synapses can occur, new movement skills can be acquired at any time, and there is potential for new neural connections throughout life, regardless of age.

As humans, we are often creatures of habit, often preferring repetition and predictability to novelty, from driving the same way every day to work, to performing the same set of sequenced asanas in a class or at home. Although there is still incredible benefit to be reaped from repetition and movement, creativity is what drives the brain, kinesthetic sense, and motor learning. With every new set of movement concepts or skills, there is a timeline of growth and acquisition that can be seen in the psychological model of the conscious competence matrix, used in many different modalities of learning:

  1. Unconscious Incompetence: The student does not know or understand how to do something, and therefore does not know their own incompetence.
  2. Conscious Incompetence: The student does not understand how to do something, but sees their own deficits and is eager to learn.
  3. Conscious Competence: Student understands how to do something but is refining the movement and skills needed.
  4. Unconscious competence: Student is able to execute the skill with minimal effort and ease.

Let’s apply this to a movement skill that I am still refining: handstands. When I first tried a handstand, I was convinced that I could not do one (having not done them in my youth), and had no idea where to start, thus the unconscious incompetence phase. I later started to realize the strength needed in the shoulders, although my kick attempts were clumsy (conscious incompetence). A few years later, I was able to kick up to the wall, albeit not always gracefully, and able to refine my kinesthetic mastery of the movement mechanics, thus conscious competence. I think I’m still somewhere in the conscious competence phase in regards to handstanding, since it’s not yet second nature, but we’ve all seen people pike and float into handstand with no problem, thus unconscious competence.

Let’s tie this all back to yoga asanas – after a certain point, many of the traditional yoga asanas (vinyasa, downward dog, tadasana, warrior poses, etc.) become very familiar, thus unconscious competence. We may have a remembered rote sense of what poses usually “feel” like, and thus replicate a similar felt experience each time. We may no longer think about the way we execute the pose, and may be doing the pose on autopilot, with little felt sense of proprioception or kinesthesia.  The same is true with musicians with warmups- I am absolutely guilty of doing the same warmup every day, and just sort of going through the motions.  How can we challenge our self learning and assessments with our instruments and habits, even after playing an instrument for 15, 20, 25 years?

The solution? Make poses and movement new again and think out of the box. For movement, my favorite way to do this is with pilates and  Yoga Tune Up®, as they have both been challenging for the brain and body in bilateral movements, new pose orientations, and joint explorations.  For music, I invite myself to warmup by improvising- if I'm working on an excerpt, I have to remind myself to approach it as if it were new, whether that be through new fingerings and bowings, playing the accompaniment parts in the orchestra, playing along with recordings, or simply challenging myself to learn new repertoire, etudes, and concepts.  Novelty challenges the brain and the body, and helps to keep us on the lifelong path of learning and growth.

Detangling the Pecs: Part 3

Image from Erik Dalton

Image from Erik Dalton

This week, we've looked a little at what the pectoral muscles do, specifically the pec minor, and how restriction with the front of the chest muscles can bring the shoulders protracted and internally rotated.  Now, how can we start to create change within those muscle groups to better balance out the shoulder joint?

1) Address the restriction on the front via awareness: is it a result of your instrument? Your sitting habits? Your driving habits? Do you notice your shoulders slumping forwards in daily activities?

2) Correction with outside feedback: It can be tempting to just think "I need to bring my shoulders back and down," but that's not helpful either.  The shoulder joint is highly mobile, and even though restriction in the front may be an issue, there may be other culprits that could use attention, whether it's in the neck, the spine, or the shoulders themselves. In addition, a shoulder blade moving forward, or protracting, may also be internally rotating. (see video below)  I'd recommend seeing some sort of movement professional (PT, massage therapist, pilates teacher, trainer, body mapper, Alexander Technique teacher, etc.) and ask for some feedback.  (As always, if you're in a place of acute pain, see a doctor for a full assessment!) Although I primarily teach pilates and Yoga Tune Up®, there are many well educated movement professionals in different fields that can help you identify your issues.  One thing I find helpful is to take pictures on a phone of your shoulders/collarbones, and just use those as a reference as you start to make changes.

The infraspinatus and trees minor are key muscles to look at strengthening.

The infraspinatus and trees minor are key muscles to look at strengthening.

3) Mobilize and Work to strengthen your external rotators of your shoulder: So for every muscle group that contracts, there is an opposing muscle group that's relaxing.  The muscles on the back of the shoulder blade are primary external rotators of the shoulder, and can help bring the arm bone back and done, but without forcing it in an inorganic way.  How does one strengthen these muscles? Most movement disciplines have some form of strengthening built in of these muscle groups, but here are some of my favorites:

This may seem really easy, but if the spine and ribs are stable, and the arm bone not moving forwards or backwards, it can be a real challenge.

This may seem really easy, but if the spine and ribs are stable, and the arm bone not moving forwards or backwards, it can be a real challenge.

1) This classic strengthening exercise involves either a theraband or a set of small hand weights (like the dinky vinyl coated ones).  One can do it standing or side lying, but essentially, the goal is to keep the upper arm bones, or humerii, stable as you pulse the hands away from the body.  This video shows how to do the same exercise in standing, with a theraband.  One can also do it in standing without any resistance.

2) Reassess your plank poses, downward dogs, or even quadruped/ hands knee poses.  Many times I see students in internal rotation from the onset of class, and learning how to externally rotate the arms in weight bearing positions in critical, especially if you practice weight bearing positions.  One of my favorite Jill Miller videos is about the challenges of downward dog for the shoulder.  If you're a yoga student, this video is a must!  Here are a few other blogs about the challenges of Downward Facing Dog.

3) Look at where you may be missing range of motion in your shoulders: I love shoulder flossing, either with a theraband, Fletcher Pilates towel, yoga strap, or other device.  This great video by Christine Jablonski shows one of my favorite Yoga Tune Up® exercises.  Although this isn't a particular strengthening exercise, it can help bring awareness to where you need mobility in the shoulder.

4) Bring some length to the front of the chest via floor angels.  This is one of my favorite exercises, and it can be down with the upper half of the body on a foam roller or bolster or block.  The number one objective is to keep the ribs down (which the woman on the right is NOT doing) to really assess where your actual range of motion is. Once the spine starts moving, you've lost the intention of the exercise.  This is a classical Katy Bowman exercise, but this video  also describes it well.

Although there are many ways to strengthen the shoulder and start to bring change into the shoulder joint, here are a just a few ways to get started~