Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

Filtering by Tag: adaptive shortening

Why Do My Wrists Hurt During my Workouts? Part 1

One of the questions I'm most frequently asked is why yoga makes our wrists hurt so much in yoga, pilates, planks, and other movements.   First thing, let's look at the small bones of the wrist and what's going on in there.

Can you tell I'm excited about my new model skeleton?

Can you tell I'm excited about my new model skeleton?

Our wrist is a somewhat delicate joint, at least in comparison to the foot, which has a very similar structure.  The eight carpal bones are very small and fit between the radius/ulna and the metacarpals.  (The phalanges are what we think of as the finger bones, but clearly, fingers start from the wrist, not the knuckles!)

We flex the wrist to type and text, we extend the wrist to do plank and down dog.

We flex the wrist to type and text, we extend the wrist to do plank and down dog.

It also means that we may not have the same range in the opposite direction that some people do.

It also means that we may not have the same range in the opposite direction that some people do.

There are many different styles of yoga, but the many flow styles these days emphasize vinyasas or the sequence of plank, chaturanga, to upward facing dog.  Even if those terms don't mean anything to you, think plank to pushup, repeated over and over, which occurs in many fitness formats.  So why does this sequence hurt so many folks?  Well, most musicians (and normal people) keep their wrists in partial flexion, whether they are desk bound, using their phone, keyboardists, string players, woodwind players, teachers, etc.  That partial flexion adds up over the years, especially if we never use the opposite range of motion- wrist extension.  The tissues of the palm, hand, and forearm, stay partially contracted, and then limit our range of extension.  One day, you decide to try yoga, which demands a lot of wrist extension plus you decide to LOAD your whole body weight on top of it, and then you wonder why things hurt.     Staying in one position for a long time (like 15-20 years, many hours a day) keeps the muscles and connective tissue in that position- making it difficult to adapt to the opposite shape of extension.

So there’s two remedies:

1) build the range of motion in extension, and 2) progressively load those tissues to build up strength. If we never use our wrists in extension, we need to gently progress with range of motion and weight, rather than putting 130-230 pounds on our hands out of the blue. That means you can’t go from zero to full plank/push up hour without some gradual change to optimize adaptation.

My wrists are sometimes tight- you can see that it's hard for my thumb to fully rest on the floor without a small bend..

My wrists are sometimes tight- you can see that it's hard for my thumb to fully rest on the floor without a small bend..

Let's get more specific- planks require full wrist extension (meaning that the distance between the back of the hand and forearm is 90 degrees) whereas down dog is more of a 60 degree angle, depending on many factors.  

Notice that the angle between the forearm and wrist is acute, whereas the other is a right angle?

Notice that the angle between the forearm and wrist is acute, whereas the other is a right angle?

Imagefrom the Melt Method, which has a terrific hand and foot massage kit!

Imagefrom the Melt Method, which has a terrific hand and foot massage kit!

So then, imagine repeating full extension over and over again when you don't actually have that full range, or you only have it on one side. In addition, it’s been days, weeks or months since you’ve done yoga, so your body hasn’t been loaded this way. 

First, let's test the range you have in your wrists right now, shall we?  Bring your forearms together in front of your chest, then allow your wrists to extend comfortably.  Don't force it.  Do your wrists naturally open to a 180 degree angle?  Or is one side more acute (hello left hand for me!)?  That explains why full extension might aggravate things!  I'll talk a bit more about poses that are wrist intensive next time, and how to help your wrists out, and possibly gain more range in the long run.

"You Are How You Move" : A Crash Course in Mechanotransduction

This comic from  Bliss  demonstrates mechanotransduction in action- our day to day movements affect our body!  How does your cell phone/ipad/screen time affect your head and neck?

This comic from Bliss demonstrates mechanotransduction in action- our day to day movements affect our body!  How does your cell phone/ipad/screen time affect your head and neck?

As I move into the second year of coursework for my training with Katy Bowman, I thought it might be nice to address an issue that I've alluded to but not directly written about: mechanotransduction.  As words go, it may not be familiar, but as a concept, you will certainly understand it.  We all know on some level that the way we "exercise" affects the shape and function of our bodies, but mechanotransduction refers to the "the conversion of movement input to biochemical processes" (Move Your DNA, pg 10).  All of your movement choices, i.e., shoes, walking, how you sit, how you play an instrument, how you stand, how you exercise...these are cellular inputs into the body, meaning that your body is constantly responding and adapting to this information on a cellular level.  We know some of this from experience- sitting casts our body in certain shapes and habits, whether or not we intend them.  So does playing an instrument, wearing high heels, wearing misfitting shoes, constantly leaning to one side, and so forth.  We usually think of this in regards to exercise, which for most people is 5 hours a week of intense vigorous activity, compared to 107 other hours a week that people are often stationary.  (Assuming average person sleeps 8 hours a day and is doing things the other 16 hours a day, times 7, minus 5).  Yet, what about those other 100 plus hours a week of movement or lack thereof?  It's important to not just look at exercise, but look at one's whole week of movement to see what habits lie within.

The way we hold our instruments causes constant adaptation in our bodies.  A lifetime of poor neck positions may result in undesirable structural adaptations!

The way we hold our instruments causes constant adaptation in our bodies.  A lifetime of poor neck positions may result in undesirable structural adaptations!

Katy Bowman discusses all of this eloquently and efficiently in her book, Move Your DNA, and really delves into loads, but here are some of the factors to look at when thinking big picture:

1) Frequency: how often a certain shape is adopted

2) Magnitude: amount of force applied

3) Location: where force was applied, what structures are most affected

4) Duration: how long action was assumed

So for example, when we talk about practicing and increasing practice time to allow tissues to adapt, we're looking at these four factors, amongst others.  If someone has been practicing a half hour a day over the holidays, and then goes back to full time symphony work of 3-5 hours a day of playing, that's a huge increase in frequency, magnitude, and duration, meaning that the tissues won't have much time to adapt in a healthful, sustainable way.  If someone rarely wears high heels, and then wears them for a whole day, that's a huge increase in all of those factors as well which might result in foot, knee, hip, or back pain. 

A lifetime of sitting in the collapsed positions on the left can create undesirable structural adaptations as well.  Image from "Sad Dog, Happy Dog" by Kathleen Porter.

A lifetime of sitting in the collapsed positions on the left can create undesirable structural adaptations as well. Image from "Sad Dog, Happy Dog" by Kathleen Porter.

Many of our modern ailments are diseases of lack of movement and mechanotransduction- a lifetime of constant sitting will cause certain muscles, fascia, and bony structures to adapt in ways that we may not want, which can result in long term damage to the body.  Many of the ailments I've discussed in the last two years are simply a result of your body processing the movement input you've given it: a lifetime of head forward posture and hyper-khyphosis will change the upper spine, years spent indulging in impractical footwear affecting the knees, spine, hips, and more, and for many of us, less than ideal ways of playing our instrument can result in negative adaptations as well.  This process of converting mechanical input into cellular adaptation is precisely why moving better, gaining awareness, and self-care is so important.  By the time your body is injured, you've sent it years of poor movement patterns, so why not retrain earlier and make positive adaptations to your structure?  In regards to music, most of us practice significantly more than we move- it's just practical math.  If someone practices an instrument 2-3 hours a day (that's a conservative estimate) for 20 years, that's probably much, much more than they exercise.  If someone is a massage therapist for 4-5 hours a day for 10 years, the shapes they assume while practicing bodywork will make a greater cellular deformation.  (Also, If someone practices yoga one hour a day, every day, that still doesn't account for the quality of movement in rest of their life!  Yoga is not the only movement your body needs!)  Now none of this has to do with the current mass media model of exercise, which is work out hard+burn calories=great looking body.  This model is looking at how your body moves, not how it looks, not how thin/fat/muscular you are, but range of motion, pain, tissue health, etc.   Although weight is one factor of determining health, it is by no means the only way to evaluate.  (And for those of who are movement instructors or have a regimented training/workout process, how is your exercise affecting your tissues and what about the movement habits you adopt for the rest of the day, week, and life?)

So the question I leave you with now is how do you move?

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What is a Muscle Knot?

Last week I mentioned the importance of getting bodywork to target muscle knots- I imagine that few people see muscle them as literal knots, but what are they exactly and how do they exist?

There are a few words to know first- trigger points and fascial adhesions.  I mentioned trigger points last week, but "a skeletal muscle tissue trigger point is a hyperirritable focal area of muscle hypertonicity (tightness) located within a taut band of skeletal muscle tissue." (Joseph Muscolino)  These areas of tightness often cause pain and discomfort, especially in those overused musician areas of the upper back.  The word trigger point came to use in the 1940's because of a Doctor Janet Travell (yes, an awesome woman pain doctor in the first half of the twentieth century!) and her research into myofascia, trigger points, and pain.

This is Dr. Janet Travell, who was also a white house physician!  Image from her website.

This is Dr. Janet Travell, who was also a white house physician!  Image from her website.

It is not something subjective, not something of which the patient complains. It is an objective physical sign in that it is disclosed by physical examination of the patient. Then, the trigger point is identified as a localized area, a spot of deep tenderness in a firm band of muscle that can be readily felt. Usually the palpable band parallels the muscle fibers; occasionally it feels like a button, or a nodule. At the spot of maximum tenderness (the trigger point), if the band is snapped briskly (transversely), and is thus mechanically stimulated, it contracts; this we have called a ‘local twitch response.’ The examiner can feel and see the line of contraction of the band, and can judge which muscle harbors it.
— Janet Travell, Basic Principles of Myofascial Pain, 1984
Remember this image from  last year's fascia post?  Fascia is everywhere in the body and is the "body's aqueous knitting fabric" (Jill Miller)!

Remember this image from last year's fascia post? Fascia is everywhere in the body and is the "body's aqueous knitting fabric" (Jill Miller)!

In some of Janet Travell's other writing, she talks about how the trigger point affects muscle strength and reflexivity, joint mobility, and radiates pain to surrounding areas.  (She was also a general badass and way ahead of her time in many other ways!)   There is a fair amount of disagreement about what causes trigger points, though we can all agree overuse, misuse, and abuse are contributing causes.  Carry a large purse on one side of your upper back and chances are, your trapezius will tighten up and eventually form a trigger point that could radiate into your forearm and neck, like the picture below. 

Images like this are usually referring to trigger points, or areas of myofascia that radiate sensation and pain to surrounding areas.

Images like this are usually referring to trigger points, or areas of myofascia that radiate sensation and pain to surrounding areas.

Now what's a fascial adhesion and is there a difference between that and a trigger point?  Andrew Biel writes that a consistently shortened or lengthened muscle will cause change within the muscle and the fascia, which may grow "dense and fibrous.  The excess connective tissue can result in fascial adhesions that affix one muscle to another, limiting range of motion."  (Trail Guide to Movement, 12)  Remember that fascia is everywhere in the body, like the white stuff in a citrus fruit giving structure to the juice within.  Your fascia can be dehydrated (think gross grapefruit!) or overgrown from a trauma or from overuse/underuse.  Adhesions address fascia, according to some folks, and also address scar tissue and an abundance of collagen from healing.  For example, if you had tendonitis in your forearm when you were younger, you may have some scar tissue lingering in that location- it might not be extremely painful but it might be hindering your ability to use your forearm and hand.  Trigger points are generally thought of as more muscular/myofascial in origin, though to be frank, your body's network of muscles and fascia is continuous!  There is a fair amount of disagreement in the manual therapy world about what causes what, and how things cause pain, and why they arise in the body, so this is just a general survey.

How can you help both your trigger points and your adhesions?  Well, go get some bodywork and talk to your bodyworker about what they find and what tissues they find acting abnormally.  Consider getting on the self-massage train and start excavating these issues yourself, and look into different types of bodywork.  Cranio-sacral vs. rolfing vs. deep tissue vs. graston technique.  Get curious!

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