Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians

Shoulder Anatomy 101-Part 1

Shoulder Anatomy.jpg

The shoulders are a mysterious place for musicians and most people-Where do they start?  What the heck is a rotator cuff?  Is it a singular muscle?  And is there a shoulder joint?  It hurts when I do (blank), whats wrong with me?  I've worked with students and fellow musicians on understanding the basic mechanics of our shoulder and upper arms, which is an essential piece of knowledge for instrumental teaching and performance, as well as a healthy lifestyle for non musicians.

Basic fact #1: The shoulder is composed of three bones: the humerus, the clavicle,  and the scapula.  No more, no less.   The humerus is your upper arm bone (underneath your biceps and triceps), your clavicle is the collar bone running laterally from your sternum, and your scapulae are the wing-like bony structure on your back.  The glenohumeral joint (i.e. where your humerus meets your scapula and clavicle), is a ball and socket joint (meaning that your "shoulder joint" is in fact your glenohumeral joint).

Basic Fact #2: The rotator cuff is not a single muscle, but a group of four muscles.   When students or friends have a rotator cuff injury, they rarely know which one of these four muscles they've injured, which is actually a bit of an issue because they do wildly different things.  Here they are:

image from "Trail Guide to the Body," by Andrew Biel.

image from "Trail Guide to the Body," by Andrew Biel.

Supraspinatus: The top-most muscle, which helps to lift the shoulder, but does little in rotation.   

Infraspinatus: The middle muscle, which helps to externally rotate the shoulder, as well as adduct. 

Teres Minor:  The lowest muscle on the posterioir of the scapula also assists in external rotation and stabilization. 

Subscapularis:  This is sort of the ugly stepchild of the rotators-hidden on the front side of the scapula, towards the internal cavity, this muscle internally rotates the shoulder and is a major stabilizer.  It's also the largest of the group.

 

 

Basic Fact #3:  While massages can help remedy chronically tight shoulder and upper back tissues, you actually have to change the posture  or habit that is creating that tension pattern in order to see lasting change.  (I.e., if your shoulder rest makes your left shoulder elevate, you then get a massage, and then play the next day without changing anything, the effects won't last. The same would be true for your movement habits, yoga practice, workouts, etc.)  One has to combine soft tissue work with postural change and awareness to see results.  (Subtle somatic practices like Feldenkrais and Alexander technique can be great for that!)

More detailed view of the rotator cuff from "Trail Guide to the Body," by Andrew Biel.

More detailed view of the rotator cuff from "Trail Guide to the Body," by Andrew Biel.

Basic Fact #4: Your posture affects your shoulder mobility.  If you're a slumper, meaning that your upper chest rounds and your head pushes forward, you're at risk for many musculoskeletal issues, (not to mention unusual tension patterns related to being a musician).  Your shoulders can't move freely when your torso isn't supporting your upper body and you can't breathe as fully if your posture is compromised. 

Basic Fact #5:  Most people need to strengthen their rotator cuff, and most people (myself included) need to improve their upper body strength.  I find that many musicians are worried about destroying their upper bodies through exercise, which is a fair concern.  Yet, muscle atrophy is not helping anyone, and lack of movement aside from playing will be more detrimental in the long run. (Find a safe upper body workout, folks!). Swim, work with a personal trainer to figure out how to start a weights routine, take a yoga class with a teacher who will focus on your upper body alignment, try pilates-whatever floats your boat.

 

 

A Quick Dose of Back Side Anatomy

Most folks have a vague idea of what's going on in their backs, but let's clarify.  In your vertebral column, you have 24 vertebrae: 7 cervical (neck), 12 thoracic (thorax-ribs area), and 5 lumbar.  The cervical vertebrae are the most mobile, giving you the ability to turn your neck in many positions.  The thoracic ribs articulate with your 12 sets of ribs to protect the viscera, assist in breathing, etc.  The lumbar vertebrae are larger, less mobile, and support the weight of the torso.

When viewed from the side, the spine has a series of natural lordatic and kyphotic curves.  Poor alignment often distorts these curves into a single C curve.

When viewed from the side, the spine has a series of natural lordatic and kyphotic curves.  Poor alignment often distorts these curves into a single C curve.

In between each vertebra is a cartilaginous "invertebral disc," which I mentioned last week in relation to osteoporosis.  These discs act as shock absorbers while also helping to maintain the structure of the spine.  Misaligned discs can be painful, or not.  Many people have slightly herniated discs (meaning displaced) and have no pain or symptoms from it while others have serious issues, including compressed nerves and persistent pain.

Image from Grey's Anatomy of Erector Spinae and intermediate spinal muscles.

Image from Grey's Anatomy of Erector Spinae and intermediate spinal muscles.

Muscularly speaking, there are many layers of muscle stacked on top of each to make up this portion of your posterior kinetic chain (a fancy way of side your backside).   Our deepest level of posterior muscles are a series of very small muscles running between individual vertebrae, specifically the transversospinalis muscles.  They assist with maintaining healthy curvature of the back, as well as bring the spine into extension, or what we think of as a backbend.  The intermediate musculature is what you see here on the right-this series of long cord-like structures, which assist in extension as well as side bending in the spine. 

Superficial musculature is often more of what you can see on someone's back side-muscles like the trapezius, latissimus dorsi, etc., both of which play a major role in moving the shoulders and neck, as well as spine.  (Lats are a big player in pull ups, and the trapezius often gets very tight and restricted in musicians).

A detailed look at the muscles of the back and shoulders, courtesy of Encyclopedia Brittanica.  The left view is the topical view, sans epidermis, and the view on the right peels one layer of back myofascia off to look deeper. 

A detailed look at the muscles of the back and shoulders, courtesy of Encyclopedia Brittanica.  The left view is the topical view, sans epidermis, and the view on the right peels one layer of back myofascia off to look deeper. 

I found this image on the internet, but I have no idea where it came from.  I do love it, though!

I found this image on the internet, but I have no idea where it came from.  I do love it, though!

Your spine moves ultimately in 6 directions- round, extend (hello cat/cow), side bend both sides, and twist both sides.  The musculature of your back (as well as the muscles of your front) help support the spine and organs as you make these movements, which help keep the invertebral discs healthy, and lengthen compressed areas in the body.  The muscles of your pelvis and abdomen are also incredibly important to postural maintenance and stability, but we'll talk about those another day.

Can you see how if a musician is short in one side of their body, due to an asymmetrical instrument, they might have misalignment and back pain?

What Does Rib Thrusting Look Like?

To read more from Katy or some others to address the rib flare, visit www.nutritiousmovement.com

To read more from Katy or some others to address the rib flare, visit www.nutritiousmovement.com

This week, I've been working with my private clients about stabilizing the ribs, whether in supine movements or extensions, and it can be helpful to have some visual context.  This is a little of what  rib thrusting or rib flare looks like, and how it is an aesthetic goal in many movement disciplines, here's a short gallery of different shapes and people demonstrating (most likely accidental) rib thrust.  As mentioned in my previous blog post, it can sometimes be misconstrued as "good posture" to have the shoulders back and chest broad...but pushing the ribs forward of the midline of the body compresses the lumbar vertebrae, negatively affects the pelvic floor and diaphragm, and can really limit actually spinal mobility.  Some people will naturally have a pelvic flare, either from movement habits, activities, (gymnastics, cheerleading, ice skating, dance, etc) or just a lifetime of movement habits.  There's nothing wrong with you if you have a little of this, but starting to be aware of it will not only improve your athletic performance, but may also help reduce pain, risk of diastasis recti, or other issues that may be present.  This rib thrusting is very common in yoga-land, especially in the context of standing postures, downward dog, and back bends.

(Click through the gallery to see different images)

In some fields, like gymnastics and dance, the rib thrust may be an aesthetic goal or just be a consequence of executing a movement (i.e., do the movement at any cost to the physical body).  For those of you who have been a little perplexed about the rib thrust and what it looks like, hope this helps!  (And take a look at my previous post for more specific details on what rib thrusting is)

Rib Flare, or Where Are Your Ribs in Relationship to the Rest of You?

Sometimes at social gatherings, people will ask me to fix their posture, AKA. "Tell Us what we're doing wrong, right now!"  This is what I tried to tell them, albeit only somewhat successfully.

As musicians, movers, and teachers, most of us have been taught "good posture" markers, like sit/strand up straight, shoulders back, head upright, suck in the belly.  Ironically, many of these cues will not yield good posture at all, but will hide the body's deficiencies through overcorrection.  For most of us, this was continue out into our daily activities, including yoga, weight lifting, running, etc. and yields rib thrust or rib flare.  What is this, you ask?  Take a look at this image below of Katy Bowman, biomechanics movement goddess. 

Image from Nutritious Movement.  Go read her books now.  I'll wait.

Image from Nutritious Movement.  Go read her books now.  I'll wait.

Take a look at the three difference variations of posture (there are infinite variations- these are just a few).  Which one looks "the best" to you?  Number three?- in which the body is upright and the shoulders back?  Or Number Two, in which the spine looks slightly rounded or kyphotic?  Also look at the vertical plumb line between the three images- only number two has the head stacked over the heels.  In both image one and three, the head is trailing forward of the heels.   Which image do you most resemble?  The "best aligned" posture of these three is not number three, but number two, in which the body's natural spinal curves are preserved, and the head, ribs, and pelvis are all in a unified line.  Number three reveals the rib thrust, which can be defined as the ribs moving forward of the pelvis which then does gnarly things to the lumbar (low back) spinal vertebrae.  This is separating an aesthetic marker (shoulders back, chest forward) from a true body alignment marker (ribs and head over hips and heels).

Time out: What are forces? Has it been awhile since you studied physics? (For me, over a decade, so force = mass x acceleration) Fear not- gravity (a force) is still working with you. There are other forces (non Star Wars related) working on you as well in movement, including tension, compression, shear, and torsion. Go read about them here!

Image from Leslie McNabb.

Image from Leslie McNabb.

So even if this whole force thing isn't making sense, you can see that the ribs are shifting forward of the pelvis, right?  What that does is compress the lower vertebrae, as well as make for some unhappy soft tissues, a dysfunctional core (can lead to diastasis recti, especially when pregnancy and post  natal issues are coming up ), and a possibly dysfunctional pelvic floor (incontinence, pain, etc.) amongst other things.   (See this woman on the right?  Does she have "good posture" or is she just masking her body's dysfunction by pushing her ribs forward and throwing her shoulders back?

Most of us have some degree of rib thrust, but it will manifest more often when wearing high heels, because the body is trying to mask the inherent distortion that high heels creates for the spine.  (Gentlemen, most likely your dress shoes have a heel, so you are not immune to this conversation)

Bad posture to bad posture- not bad to good!  Image on left shows the over-rounding, or kyphosis of the upper back with the pelvis forward of the heels, image on right shows rib thrust, to appear to have "good posture."

Bad posture to bad posture- not bad to good!  Image on left shows the over-rounding, or kyphosis of the upper back with the pelvis forward of the heels, image on right shows rib thrust, to appear to have "good posture."

Let's review- in the rib thrust, the bottom most ribs are shifting forward of the pelvis, which draws the scapula back and creates the illusion of good posture (upright body, broad collarbones).  It is in fact masking the issues at hand, which are lack of mobility in the thoracic spine, and possibly hyper-kyphosis, as seen in the image on the right.  So what can we do about the over-slump?  Start to work on thoracic mobility, shoulder mobility (with stable ribs), and keeping the bottom-most ribs down.  

So first, do some exploration, and see where you fall in the spectrum- where are your ribs hanging out?

Here's some more reading about rib thrusting!

"R U A Rib-Thruster" by Katy Bowman

"When Good Posture is Actually Bad for You" by Leslie McNabb

"When Is a Backbend Not a Backbend?" by Jenni Rawlings

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