Musicians' Health Collective

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

Filtering by Tag: basics

Bones of the Arm and Forearm

Most musicians have a vague idea of where their arm bones are, but let's get a bit more specific here.  

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If you were a child of the 80's and 90's and you remember amazing slang like "tubular" and "radical" and Wayne's World, this reference will make sense.  Otherwise, work with me.


Now before we get more complicated, is everyone clear?  The upper arm bone is the humerus, which I previous covered in shoulder posts.


Here's a more detailed and accurate image for this, from Paul Roache, an orthopedic specialist in northern California.  Why is this relevant?  In order to talk about the muscles of the wrist and arm, as well as tendon and nerve issues, it's good to be clear about the basics first.  

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Sitting Better

by Kayleigh Miller

I thought I would initially write a detailed anatomical post about the finer points of sitting.  Frankly, this video demonstrates everything I would want to say, and more.


Katy Bowman, a fabulous and interesting lady in the realm of biomechanics, PFD (look it up.  I'm not explaining it.), and general foot well being has made this hilarious video.  The pelvis next to the human illuminates the fundamental basics of sitting-pelvic tilt.  She's demonstrating how posterior pelvic tilt affects upper body alignment, specifically by enhancing rounding in the upper body.

This image from  basically just reinforces this idea.  Wow!  That looks uncomfortable...but we all do it sometimes.  It is also possible to be anterior tilting the pelvic too much, though that's more difficult to do while playing an instrument.

This image from basically just reinforces this idea.  Wow!  That looks uncomfortable...but we all do it sometimes.  It is also possible to be anterior tilting the pelvic too much, though that's more difficult to do while playing an instrument.

Next time you sit-maybe even now, play around with your pelvic tilt and see how the relationship affects your spine, head, and how you hold your instrument (or play piano or sing or conduct).  

Clavicles and Pecs

by Kayleigh Miller

Go to a mirror right now, and take a look at your collarbones.  (Take off any extra layers of clothing first, of course.)  Your collarbones "should" be parallel to the floor, and ideally, would be symmetrical.  However, most aren't.  Take a good look-do they form more of a V shape?  Is one noticeably higher than the other?  How does that affect the distance between your neck and your shoulders?   Is one of your shoulders more rolled forward than the other?

(Fact: My left collarbone is noticeably higher than my right.   My left shoulder is also noticeably tighter than my right, and no, I'm not sharing a picture of my clavicles).

As I mentioned in last week's shoulder 101 posting, the collarbone, or clavicle, is one of the three bones of the shoulder joint.  The asymmetry in your clavicles invariably is a reflection upon what's going on in your soft tissues in your shoulder and chest, whether they be work-related, injury-related, or the result of postural patterning.   I mentioned the key players in the rotator cuff last week, but the muscles of the anterior body also affect shoulder mobility.

This older drawing from "Gray's Anatomy" shows how the muscles of the chest can govern the position of the clavicle and the shoulder. 

This older drawing from "Gray's Anatomy" shows how the muscles of the chest can govern the position of the clavicle and the shoulder. 

Pectoralis Major:  This large chest muscle helps to internally rotate the shoulder as well as flex (arms overhead) and adduct (bring the shoulder and arm back to the body).  If you look at bodybuilders (not that I do that often), they have huge pecs, and consequently have limited shoulder mobility and range of motion.  They often have a rounded upper back and rounded shoulders as well.

Pecoralis Minor: This muscle attaches the ribs to the coracoid process, which is a small hook-like portion of the scapula.  Basically, it connects your ribs to your shoulder.  It assists in depressing the scapula (lowering the shoulder away from your ears), and abducting the shoulder (lifting the arm away from the body).  As you can imagine, if this muscle is extremely tight, your shoulders will roll forward and one or both clavicles could form the v shape. 

Subclavius:  This small muscles runs underneath the clavicle, and assists in depressing the clavicle, lifting the first rib in respiration, and stabilizes the shoulders.  


What this means is that the rotator cuff and trapezius are not the only big players in your shoulder mobility and posture, and that stretches and poses that address the front of the chest as well as the posterior shoulder tissues are essential to a healthy and happy shoulder. 


Muscles, Tendons, and Ligaments-the Basics

by Kayleigh Miller

     Most musicians have a general idea of anatomy in that they know they possess various body parts, they just don't know where they are or how they work.  In fact, most folks don't really know where their shoulder is or that the rotator cuff is in fact a group of muscles controlling different actions.  This is less a reflection of the intelligence of musicians, and more a sign that anatomy and physiology is simply not taught in higher education for musicians.  Let's start with understanding musculoskeletal basics.


Skeleton: Function is to support the body, create an anchor for muscles and act as a shield for vital organs.  You have 206 bones in your body,  which contain osteoblasts (making new bone) and osteoclasts (breaking up old bone.)  Your skeleton has the capacity to change over time, which is why we can improve bone density with exercise and nutrition.

Muscles: Their function is to move bones, put simply, and are arranged in pairs which contract-extend to create movement.  There are involuntary and voluntary muscles, and your largest muscle is...your gluteus maximus (which in conjunction with your gluteus medius can affect your hips, low back, and general life comfort if too weak or too tight). 

Tendons: Primarily attach muscle to bone, and sometimes attach muscle to muscle.  They are composed of collagen, and an injury to a tendon would be called a strain (although there are plenty of other ways to injure a tendon).  Most of the movement in the hand is executed by muscles that originate in the forearm, connected to the hand through tendons.

Ligaments: These attach bone to bone, acting like the duct tape keeping your bones together underneath all of your other tissues and organs.  If you think of a model skeleton with metal rods keeping it standing up, your ligaments provide a similar support.  If you injure a ligament, it is a sprain (as opposed to a strain).   Some of the most known ligaments are those of the knee-the ACL, or anterior cruciate ligament, for example. 

Therefore, tendonitis, is an inflammation of a tendon, which connects muscle to bone.  One of my teachers describes the pattern as, "Overuse in one direction will lead to weakness and stiffness in other areas."  Treatment can be complicated, depending on the area afflicted, the movement pattern that caused the tendonitis, and the overall state of the tissues surrounding the injury.  I personally have found bodywork, acupuncture, and rest to be the most helpful in my recovery process, but seeking a medical opinion, especially in nerve entrapment situations, is important.

Overuse-what is it exactly?

by Kayleigh Miller


Most musicians have experienced some degree of fatigue after a long day of playing, whether it is intensive practicing for a concert or audition, or extensive rehearsals and a long day of school.  The problem is what to do when the discomfort doesn't go away, and that is when general panic ensues.  The thoughts about "my career is over," "I'll never get into ____," "I'll fail my jury," etc. start to percolate, and stress does not help inflammation.  Here are the most basic risk factors.

Overuse causes can be fairly simple:

1. Rapid increase in practicing.  Whether it's going on a holiday before an orchestra festival, and suddenly jumping into 6 hours a day of work or taking on extra rehearsals before a concert, dramatic increase in playing one's instrument can yield immediate pain.

2. Misalignment.  This is a broad category, and alignment and biomechanics are a subject unto themselves, but can refer to one's posture, how one holds an instrument, tension release patterns, instrument setup, or even chairs, shoes, and music stand height.

While either of these two factors may not yield an immediate pain response, over time, there can be damage if left unchecked.  Here are Janet Horvath's "Danger Signals," from her book "Playing Less Hurt," which are signs of a current or future injury risk.

1. Pain and/or burning sensation

2. Fatigue or heaviness.

3. Weakness

4. Impaired dexterity

5. Tingling, numbness.

6. Clumsiness.

7. Stiffness.

8. Involuntary movement.

9. Impaired circulation.

10. Difficulty with normal daily activities.
— Horvath, Janet. Playing (less) Hurt: An Injury Prevention Guide for Musicians. 2nd ed. New York: Hal Leonard, 2010. Kindle. (loc 79- out of 5559)

Regardless of where you fall on the spectrum of overuse, or whether you think you may be at risk, here are some basic suggestions:

1. Take breaks while practicing. I've seen a wide variety of break time suggestions, from a few minutes every thirty minutes of work to ten-fifteen minutes every hour.  Experiment with what works best for you.

2. Warm-up before "going for the gold," so to speak.  Give your muscles a chance to acclimate before pushing them to capacity in rehearsal, personal practice, or under pressure.

3. Evaluate your setup and talk to your teacher, a movement instructor, or an injury specialist to start to look at your personal tension patterning or misalignment tendencies.

4. Start noticing your basic wellness routine: do you sleep consistently?  How's your stress management?  Nutrition? Exercise?  Stretching and strengthening? Where are you contributing to injury in other areas of your life?

While there are many different types of overuse injuries, as well as a wide range of complex contributing factors, these are some basic concepts to help you and your students.

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