Musicians' Health Collective

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

Filtering by Tag: bunions

Suzuki Turn-Out No More

Who decided that we should all stand with one foot forward and externally rotated?.jpg

     I started my humble music career as a Suzuki violinist, beginning at the age of 6.  While there are many useful and important things I learned in my early training, standing position was one that has posed confusion as I've aged.  Let me explain a bit more, for those non-violinist or violists out there.

This is a perfect example of learning "proper" violin stance.  Start with the feet together, then turn the feet out (externally rotating hopefully from the hip, hopefully) and then step the left foot forward.

This is a perfect example of learning "proper" violin stance.  Start with the feet together, then turn the feet out (externally rotating hopefully from the hip, hopefully) and then step the left foot forward.

When one learns beginning violin, often one is told to turn the feet out and step the left foot forward.  I learned this way, and stood this way for a long time.  (Over 15 years, at least).  A few years ago, I started noticing that in yoga, pilates, and weight training, we were told to have both feet pointing forward, at least sometimes.  I instead wondered, why do I always turn my feet out when I play, and does it actually serve me?  I have since started experimenting with this concept. 

This adorable image is from Shirley Givens' violin series, showing that left foot turnout.  In addition, the illustrated girl puts much more weight on her left foot, enhancing the asymmetry of the stance.

This adorable image is from Shirley Givens' violin series, showing that left foot turnout.  In addition, the illustrated girl puts much more weight on her left foot, enhancing the asymmetry of the stance.

So what's the big deal?  Our feet naturally point forward or with a minimal turnout, and you may already remember that when you walk with your feet extremely turned out, there are potential consequences for foot, knee, and hip issues.  (In addition, when feet point forward rather than externally rotated, the musculature of the foot is better able to support the body in standing and walking, and the ankle joint is able to articulate more fully.)  From a biomechanical perspective, I don't understand why music educators have been teaching students to externally rotate their hips while standing, and I definitely don't understand why one foot needs to be in front of the other.  I just don't.  (Who decided this was a good idea?)  However, I don't only care about the feet, but I care also about what is happening in the hips too.  When one hip is perpetually externally rotated (left hip), we can exaggerate that asymmetry out of the practice room, and in our daily walking, standing, and movement lives, even if we don't intend to.  That means that one set of external hip rotators is constantly working more than the other set, which can affect the muscles, bones, and connective tissue over time.  What does that mean? 

See how the right side is higher than the left?  Mine is the opposite-my left side is shorter than my right.  Pelvic tilt Image from http://medical-dictionary.thefreedictionary.com/

See how the right side is higher than the left?  Mine is the opposite-my left side is shorter than my right.  Pelvic tilt Image from http://medical-dictionary.thefreedictionary.com/

Side note, I came to this conclusion because of certain issues I was having in my hip, and that I was seeing in other colleagues of mine.  Here are some of my personal symptoms, which may or may not be yours:

1. My left hip has consistently turned out more than my right, whether I'm in music mode, standing, cooking, walking, running, etc. This can simply manifest as the foot turning out, at least in appearance. Both hips want to turn out in standing though.  I've been working on gently bringing the legs back to neutral, and found that to be helpful.

2.  This in turn can cause my left external rotators of the hip and the low back muscles to be unruly.  (Muscles include my gluteus medius, TFL, Quadratus lumborum, and the iliotibial band of fascia.

3.  I also have the beginnings of a baby bunion on my left foot which may be impacted by the external rotation of the hip.

4.  From a combination of asymmetrical music-making, left side dominance, and a host of other things, my entire left side is loads tighter (less range of motion from sole of the foot up to the shoulder!) than my right, which means that I sometimes have back pain and other issues on just the left side.  

So what's the solution?  Start to get curious. It's also important to remember that correlation does not imply causation- my left hip/back issues aren't inherently caused by the turn out, but I would venture to say that the perpetual external rotation has impacted things.  I will say that my pain has diminished exponentially since I've been doing pilates and other movement activities that have challenged my hip range of motion and stability.   

Ask yourself:

-How do you stand when you're playing? Where are your feet, knees, and pelvis?  What sort of shoes do you normally wear?  How might those be affecting your lower body?

-How do you teach your students to stand?  If you have a specific way of teaching stance, why do you teach what you do? 

-Try standing differently.  Maybe feet closer together, more parallel, right leg in front, both legs in the same orientation...give yourself permission to experiment, and perhaps that will change how you teach.

-Do you sit when you practice at home, and if so, what are your legs doing?

-If you photograph yourself (or video) while playing, what does your standing look like in context?

-Do your feet turn out when you walk/run/play/sit/etc?  Start experimenting with changing that setup gradually and see if it changes how you feel.  It can have ramifications all around the lower body, specifically feet/knees/hips/spine, but maybe affects other aspects as well.

Playing an instrument requires movement within the body- it's not meant to be a static endeavor, but repeating the same position in perpetuity for twenty plus years may not be the best.  

 

Shoes: Part 4, or On Feet and Their Relative Happiness

So now, I've bullied you into realizing that your current shoe choices may not be the best for long term health.  Fret not!  Small changes can have great effects.  Let me start off by saying that there are TONS of great PT and general foot exercises out there.  Here are just a few of my favorites for now, but I'm sure I'll add more.

1. Sitting seiza vs. sitting kiza.  This rock-star dude is demonstrating these two positions.  The top position is with the toes tucked, ankles together, or kiza.  It is a position in many different movement traditions, including some martial arts and bodu.  It's also intense and stretches out the myofascial tissue in the sole of your foot.  Sitting seiza is with the tops of the feet down, stretching out the tops of the ankles.  This can be really intense, and to deal with it, I give students a rolled up blanket under the tops of their feet.

Toespreading.JPG

2.  Stretch out those adductors (to prevent bunions).  The adductors of your toes get incredibly tight from those tiny toe boxes.  I like to wear these toe-spreaders every day, but you can also rock these socks if it's too cold to go barefoot in your home.  Neither is very expensive.  General toe socks won't really stretch your adductors in the same way that these two do, but they can be a reminder that you have more adduction range in that area than you realize.  You can also manually interdigitate, which Susan McLaughlin explains in good detail on her excellent blog.

3.  Roll it out!  Grab a Yoga Tune Up® Ball, a Pinky Ball, a lacrosse ball (a bit more intense) or a tennis ball, and start to roll out the bottom of your foot.  Try it free form-roll along the inner arch, the outer arch, sideways, front back, let the ball sink into the ball of the foot and heel...you get the idea.  Here's a YTU® video to start.

4.  Make an outline of your feet on paper, like you did when you were a kid.  Then take that map and compare it to your shoes...notice which shoes don't give you space for your toes/width/bunions/etc. 

5.  Try grabbing things with your feet (just for fun and dexterity.)  When I teach kids yoga, I give each kid a batch of marbles that they then have to carry with their feet/toes to a jar.  It's definitely insightful and fun.

6.  Try toe taps (not the pilates move).  Try to lift up both of your big toes and none of the other toes.  Then try to lift just your "pointer" toe...and then your middle toe...and then you realize it's not really possible.  You can manually lift up and hold down those toes in alternation just to bring some awareness to that area.

These are just a few ideas to start-more to come!

On Shoes: Part 2

Now that I've got you hooked into this scintillating tale of podiatry woe, let's examine shoes and feet again, and look at some of the culprits to pain.

Heels: I know I've looked at what goes on in the spine, but let's look broader.  Much of this is from Katy Bowman's work, and her two subsequent books, which are excellent.

Doriflexion-plantarflexion.gif

1.  Heels increase plantarflexion, which increases tightness in the plantar fascia, which is unpleasant!  (plantar fascitis, anyone?) 

2.  Heels actually shorten your calves and achilles tendon, which is no good if you say, do any athletic activity on the planet.  That's how the illusion is maintained-your muscles are being adaptively shortened.  Are you a runner that wears heels by day?  Yikes!  Painful! (I started noticing this sensation about three years ago, when I would wear heels, followed by running, followed by super tight calves and psoas of steel.  Not in the good way.)

3.  The plantar flexion and downward push jams the foot down into the tiny toe box, which only exaggerates your chance for bunion and hammertoes and icky foot issues.

4.  Heels contribute to knee joint degradation and osteoarthritis.  Holy smokes, stop there!  I've mostly stopped wearing heels because of my meniscus damage from a bike accident.  I am still woefully guilty of a few elevated sandals and some dress shoes, but I'm slowly whittling my collection down, year by year.

5.  Changing the position of the spine can lead to back pain, as well as saw in post 1.  If you hyperextend your knees while standing and then flatten out your lumbar curve, it hurts!  Why would you add an instrument to that instability?

Aside from my sheer pallor, notice how toes tend to grip in flip flops as you walk...Not so great!

Aside from my sheer pallor, notice how toes tend to grip in flip flops as you walk...Not so great!

Flip flops: The classic summer time shoe...that's causing your toes to grip and your plantar fascia to tighten.  At summer festivals and in warm climates, folks like to wear flip flops outdoors and then change into dress shoes for concerts.  While flip flops are often flat (if they're not, see above!), your toes are gripping on for dear life to keep that shoe in.  That gripping is toe flexion, as well as a tightening of the plantar fascia, which can once again, lead to plantar fascitis.  Try sandals with a back strap, and with open toe boxes so your toes can spread, be free, and be happy!  (Men, this applies to you too.)  Maybe save the slippers for the beach?  Obviously, if your flip flops are flat, it's not going to affect your performance while standing or sitting unless you have plantar fascitis, which is icky and painful.  Don't forget that we change our gait pattern when we wear flip flops, often dragging our feet or just flinging our leg in front of us, rather than pressing off with the back foot.

Start looking at your shoe collection-what do you wear for long walks?  Running? Concerts?  We all have heels and flip flops and elevated running shoes, which are fine for occasional use, but not as a daily shoe.  Look at your sneakers too-is there a huge padded heel?  That may affect your spine as well.    Start wearing flats (Toms are my go-to, or these fun new Vibrams) for longer walks and notice if there's a change in your feet, your gait, and your overall body.


Tag Cloud Block
This is an example. Double-click here and select a page to create a cloud of its tags or categories. Learn more

On Shoes: Part 1

     There have been a good amount of useful articles lately about shoes and how they impact our posture and our spine. Why should you care? 

Question 1: Do you have back pain?  What about knee pain?

Question 2: Do you have bunions or baby bunions?

Question 3: Do you have plantar fascitis?

Yes?  Then you should care.  One of the tricky aspects of a performance based career is the performance attire, which for women, often translates to tall high heels with a small toe box.  Men aren't off the hook either though!  A small toe box (like these guys) can translate to gait issues and bunions.  Add that to wearing crazy dress shoes a few days a week, coupled with high heel boots, flats with small toe boxes, and turned out feet, and it's a disaster waiting to happen.  Not only that, your feet are the root of your standing position, whether it's in performance or in life, and can be the source of a whole chain of postural and muscular imbalances.

Even doctors 70 years ago knew that small toe boxes hurt the feet-yet we still have so many uncomfortable shoe options!  This is from my 1940's book "The New Modern Home Physician."

Even doctors 70 years ago knew that small toe boxes hurt the feet-yet we still have so many uncomfortable shoe options!  This is from my 1940's book "The New Modern Home Physician."

First thing-what's a bunion?  Basically, the muscles and bones around the big toe start to create a bulge on the medial side of the foot and the big toe turns laterally.  Huh?  Not only is it uncomfortable, but it's not pretty.  Both men AND women get them, and it's not just from high heels.  Notice how in the first image, there's space for the toes to spread a little.  Then in the second, the toe box (i.e. the space in the shoe for the toes) gets smaller and the toes start to cramp.  And then the third, the pointy shoe, is just a full out bunion fiasco.  Basically, you just want to have more space in your shoes for your toes!

I've seen this image in a few places, name  Katy Says  and a bunch of other foot related blogs which I think borrow it from her.

I've seen this image in a few places, name Katy Says and a bunch of other foot related blogs which I think borrow it from her.

Second- how do high heels affect things?  First of all, smarter foot people than I have written TONS about this, so if you're curious, there's lots more to read.  When you wear an elevated heel, you increase the posterior tilt of the pelvis which is a causation of the slumping of the upper spine.  In addition, heels flatten the natural curves of the spine, the weight distribution between ball of foot and heel is disrupted, and you start to reduce your joint range of motion.  Not only that, but you start to walk weirdly, taking little teeny steps and overarching your thoracic spine.  Remember, this includes all heels, which includes running shoes, boots, dress shoes, etc, not just fancy high heels for the ladies!

Notice how in the first picture, the woman has a natural curve to her spine?  The second image shoes how our gravity is pitched forward in heels (any heel here, folks), and the third shows the repercussions.  This woman bends her knees more, and the curves in her spine are exaggerated.  Some folks do the opposite, and hyperextend their knees and flatten their spine.


Here are a few other postural variations- the first example is similar to the above image, the second shoes more thoracic slumping, the third shows a neutral position, and the fourth shoes the hyperextension of the knees leading to forward thrusting of the chest.  Does that sound comfortable?

Here are a few other postural variations- the first example is similar to the above image, the second shoes more thoracic slumping, the third shows a neutral position, and the fourth shoes the hyperextension of the knees leading to forward thrusting of the chest.  Does that sound comfortable?

Don't believe me?  Here are some more articles:

Katy Says

Spine Health Institute

Dr Nick's Blog: What Happens With Traditional Running Shoes

And in addition, there are a TON of articles attempting to defend high heels.  Use your own myth busting skills here and think about it!

Great Posture: Another Reason To Wear Heels

Five Reasons Heels Are A Good Investment

Next post will be on some solutions to these dilemmas, as none of us (including me!) are free of heeled shoes with small toeboxes.






Powered by Squarespace. Home background image by kayleigh miller.