Musicians' Health Collective

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

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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

Walk It Like It's Hot

Neon pink vibrams are optional.  Natural terrain walking for the win!

Neon pink vibrams are optional.  Natural terrain walking for the win!

People often ask me, "If I can do just one movement thing to improve my overall health, what would it be?"  And although there are a million great possible answers (manage stress better, meditate, self-massage, move more, sleep more, eat plants), I usually answer that you, me, and everyone we know should walk more (stats on that here).  Last year, I decided to walk 2015 miles ( I really got to 2038) and see how it affected my health, and honestly, it was great.  It got me out in nature more often, my back pain decreased, my hip strength increased, my foot and calf mobility increased, and I listened to SO many podcasts and audiobooks.  I learned a ton and I'm still learning lots.  In the words of Levar Burton and Reading Rainbow, don't just take my word for it:

1) Walking is a foundational human movement, yet our modern society has essentially made it easy to skip walking as frequently as possible.  You can park a car close to the market/post office/pharmacy, walk 10 feet from your car into the store, and back out.  Many communities don't have as many public transportation options, so people rely heavily on their cars for transportation rather than walking to do daily tasks, such as going to the post office, market, etc.

There are definitely downsides to fitbits and other technology, and I don't wear mine in the house, while practicing, or when I'm not walking, but it's helpful to keep track of miles for the year, especially if you don't want to use "Track My Walk" on your phone.

There are definitely downsides to fitbits and other technology, and I don't wear mine in the house, while practicing, or when I'm not walking, but it's helpful to keep track of miles for the year, especially if you don't want to use "Track My Walk" on your phone.

2) Walking doesn't demand fancy equipment, high tech shoes, expensive workout clothing, or other gear (fitbit or other tracker not needed!).  Although walking in one's own neighborhood may not always be possible depending on the time of day, weather, safety, etc., it is something that is versatile and that can be (hypothetically) done anywhere.  (Just make sure you're not walking in heels, heeled boots, etc...)

3)  Walking can be social- it's an opportunity to spend time with your children, partner, friends, and family, whether it's in your neighborhood or out in nature.  Hitting two birds with one stone (social time plus movement plus nature) is always a win.

4) Walking is a movement that can build bone density and prevent osteoporosis, as opposed to cycling or swimming, which are not weight bearing motions working in relationship to gravity.  Women in particular, whether they are young or old, need to be doing movements that build local bone density, especially if their family has a history of osteoporosis.  Here's an article from the NY times about bone density and cyclists

5) Walking is a less intense physiological experience than running, putting less strain on the knees, heart, pelvis, and spine, especially if you only run on pavement.  (More on that another day)  Walking is a gentler way to get in daily movement, develop endurance, improve circulation, strengthen muscles, and support joints.  It obviously burns calories, and there are varying opinions about whether walking burns the same amount of calories as running.  To the running vs walking debate, I would say it depends on where you're walking/running, how you're walking, how you run, what shoes you wear, surface, grade, etc.    (i.e. run 3 miles vs walk 3 miles)

6) Walking can improve symptoms of hypertension, cholesterol, diabetes just about as well as running, which is terrific for populations of people who are not runners, who may not be able to run, may carry excess weight on their frame, or who want to improve health without potential risks of high intensity cardio.  Also, walking can be an awesome stress reducer- I often feel much better after a long walk.

Getting outside and off of the pavement means you might see actual animals, which is always a plus.

Getting outside and off of the pavement means you might see actual animals, which is always a plus.

7)  Walking in flat, minimalist shoes on natural terrain can help mobilize the small bones of your feet, strengthen the small muscles in your feet and calves, and strengthen often ignored muscles in your hips, legs, and lower limb.  Most of us walk on pavement, so integrating different terrains (rocks, sand, soft earth, etc) will actually change the loads to your feet profoundly!  Read Katy Bowman's blog on this here!

8) Walking in flat shoes on natural terrain will also challenge your in terms of grade, i.e. hills up, grade down, etc.  When we typically walk on sidewalks, there are very few hills and variations in gradation, which limits our ability to strengthen our glutes and hamstrings, as well as challenge our ankles and feet.

9) Walk while doing other things- I love to make phone calls while walking or listening to podcasts and audiobooks.  It's a great way to do things that need to be done while integrating some movement into my day.  Also, where can you walk to do errands?  Can you walk to the post office, coffee shop, yoga studio, gym, farmer's market, or work?  Get two things done at once!

Even though my dog is quite blind (and sometimes runs into things), she loves going outside for walks.  She also loves sleeping on pillows.

Even though my dog is quite blind (and sometimes runs into things), she loves going outside for walks.  She also loves sleeping on pillows.

10)  Walking is beneficial for everyone.  Whether you're a cyclist lacking bone density, or a heavy weight lifter or cardio enthusiast, walking is a different physical and physiological exercise than "working out."  It's what Katy Bowman calls a movement macronutrient- something essential for human life.  For folks working with organ prolapse, pelvic floor disorder, and diastasis recti, looking at alignment in standing and walking is a MUST. Also, running is not the same physiological experience as walking and even if you're an amazing runner, you may have some body blind spots because of your lack of walking!  If you're a runner, walking on natural terrain will be a completely different experience than running a race on pavement or using the treadmill. 

With that, I'm going to go walk my mostly blind dog around the block.  (PS.  She loves walks)


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Help-I bruised my tailbone!

It's embarrassing sometimes to admit, but I have bruised my tailbone...twice.  Neither time was particularly graceful, and both times involved falling on my tailbone, and that's all I'll say about that.  Clumsiness aside, bruising your tailbone, technically called your coccyx, is incredibly painful, especially if you have to sit for a living.  In the last 3 weeks, 3 different colleagues have talked to me about past or present tailbone pain, and the difficulties and discomfort of bruising what seems like your butt, but is really the culmination of your spine.

So how does one bruise a tailbone?  Good question.  A bruised tailbone can be an injury to the tailbone itself or the tissues surrounding it.  It will likely hurt the most when sitting.

1.  Sudden impact- this can mean falling in any capacity, whether in a contact sport, or in day to day life.  If someone pulls a chair out from underneath you, you would fall, most likely on your tailbone.  Sports such as soccer and football can also lead to similar falls.

2.  Repetitive strain- horseback riding, biking, rowing, anything that puts the torso forward of the pelvis could strain the ligaments surrounding the sacrum and coccyx.  In horseback riding and mountain biking, the bouncing and jostling can also catalyze discomfort or damage.  

3.  Childbirth and pregnancy can also lead to strain for the muscles, ligaments, and tendons surrounding the tailbone.

What will help with the pain and discomfort?

1. Wear flat shoes.  Any elevation in the shoe heel will change the angle of the pelvis and change the load on tissues surrounding the tailbone including the pelvic floor. 

One of these  cut-out cushions  could help relieve some of the pain of sitting.

One of these cut-out cushions could help relieve some of the pain of sitting.

2.  Consider sitting on an elevated cushion to help keep the pelvis in neutral while seated.  While different cushions will work for different people, even a rolled up towel on the back part of your car seat or orchestra cushion can help.

3. Heat therapy can help any back spasms or hip discomfort triggered by the bruising. Icing could aggravate the issues, as pointed out in this article.

4. Acupuncture around the back and hips can also be helpful- I've personally found it to be great for addressing my back issues in general.

5.  Initially, you won't want to or need to massage the tissues surrounding the tailbone or low back.  Once the acute pain has diminished, having a skilled bodyworker address your low back and hips can be really helpful.  You can also start to self-massage with a soft implement (no lacrosse balls!), like a tennis ball or YTU ball at the wall. 

6.  Walking can be a great movement option for your back and pelvis when other forms of exercise are too painful. (Assuming you're wearing flat shoes while walking!)

7.  See a medical professional- although my doctor prescribed painkillers and told me it would get better eventually, your doctor might have a few better options for your recovery, including PT, insurance covered acupuncture, or insurance covered medical massage.

8.  Strengthen the other muscles of your back.  For me, this was really important once the acute pain diminished.  I found that low back strengtheners like locust pose, baby cobra, and sphinx helped with my pain but also improved my proprioception of my back as a whole, and paved the way for a stronger back post recovery.

9. Sit better, making sure that you're sitting on your ischial tuberosities and not your tailbone!  Perhaps you can sit less too?

Although tailbone pain can be embarrassing, it's not uncommon!  Be patient with yourself as you recover and know that the pain will dissipate with time.



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Your Spine and Hips are Suffering from Your High Heel Use

I'm getting ready for my healthy feet workshop next Saturday, and came upon yet ANOTHER idiotic article on how high heels are "healthy."  Here's one of my favorite quotes:

“You shouldn’t walk in heels higher than three inches,” she says. “Anything over the three-inch mark changes the biomechanics of how you walk—your strides are shortened, you can’t walk as fast, your body weight shifts to the ball of the foot, which throws off your center of gravity and stresses the knees and lower back.”

Um, hello?  All high heels do that.  Not just ones over three inches- all elevated heels affect your gait pattern and standing, so here's a video I made last year showing how standing is affected by heels.  Do you believe me yet?  Also, this crazy article in the NY times reminds us that there are people wedded to their heels in crazy ways!

Just as I did in the video, can you see how I can arch my upper back (AKA. thrust my ribs forward) more to stand up "straight"?  Or I can bend my knees and create hyperkyphosis in the spine in A, or B, hyperextend/straighten the knees and overarch the lumbar and thoracic curves.  In addition, you can hyperextend your knees and look more like letter B.  There are quite of few combinations of these postural tendency.  What do you think the effect of these shapes are on your body? Every time you wear any sort of heel, even a low heel, you are affecting the geometry of your joints, your natural gait pattern, your ankles, knees, hips, spine, and pelvic floor muscles! 

Just as I did in the video, can you see how I can arch my upper back (AKA. thrust my ribs forward) more to stand up "straight"?  Or I can bend my knees and create hyperkyphosis in the spine in A, or B, hyperextend/straighten the knees and overarch the lumbar and thoracic curves.  In addition, you can hyperextend your knees and look more like letter B.  There are quite of few combinations of these postural tendency.  What do you think the effect of these shapes are on your body? Every time you wear any sort of heel, even a low heel, you are affecting the geometry of your joints, your natural gait pattern, your ankles, knees, hips, spine, and pelvic floor muscles! 

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