Musicians' Health Collective

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

Filtering by Tag: carrying

How the Things We Carry Hurt Us

Musicians have it rough- simply practicing our instruments leads many to pain, either from the sheer volume of practicing, long held misalignment, or from overuse.  But for many musicians (and normal folks too!), simply carrying our instruments (and purses, man-bags, totes, etc.) can be painful, and can lead to many other shoulder, forearm, and back issues, as well as nerve impingement.  Instruments in their cases can be anywhere from 7-30 + pounds, and many people carry them on one shoulder, or with one arm for periods of time which can result in long term damage.

How is your purse/case/messenger bag deforming your body?

How is your purse/case/messenger bag deforming your body?

Let me start with a shout-out to biomechanics and Katy Bowman's awesome book, Move Your DNA.  In her book, she takes about how our bodies are impacted by all of our movement, or lack thereof, which includes carrying things, walking, squatting, moving, practicing, etc.  Our body shape on a cellular level is impacted by these loads, which displace and deform the body.  This process, in which the body inputs load/movement is called mechanotransduction.  These are fancy ways of saying the way you move impacts all of your tissues on a cellular level, each and every day.  Now with carrying things like cases and purses and totes, we have to think about a few different components:

1) Magnitude (how much it weights and how large it is)

2) Location (which shoulder/arm you usually carry it on, side, etc.),

3) Duration (how long you carry it in the SAME position- if you live somewhere where you walk or bike with a case, are you always carrying it in the same way and for how long?)

4) Frequency (with which you carry it in the SAME position)

Ultimately, your body is always adapting to the load that you bear, which means that your soft tissues (and bones and muscles too!) are changing in response to carrying your purse, case, etc., even if you don't expect or want them to.

Let's start with some heavier case/instrument weights by the numbers :

Violin/viola in case: 5-12 lbs, depending on case materials and if there is music in case

Cello: anywhere from 10-20+ lbs, depending on case and music

Bass: (7/8 or 3/4 size) bass alone weighs 25-30 lbs, add a soft case and you're in the 30's to 40's

Presenting the contrabassoon, which according to amazon (who knows if that's true!), weighs about 45 pounds without the case. 

Presenting the contrabassoon, which according to amazon (who knows if that's true!), weighs about 45 pounds without the case. 

French Horn: 20-30 lbs, depending on case

Bassoon: 7-12 lbs, not including the horrors of carrying a contrabassoon

Trumpets: trumpets are light instruments, only 3-5 lbs, but most professionals carry at least two, which puts the weight between 10-20 lbs

Tuba: tuba alone weighs 25-35 lbs, so factor in the case to bring it into the 30's

Let's not even talk about percussionists, who may be bringing 100 pounds of mallets and accoutrements with them to rehearsals.

Notice how the shoulder on the left has to raise in order to support the bag?  Every time you carry your  case on one shoulder, you are reinforcing this pattern.

Notice how the shoulder on the left has to raise in order to support the bag?  Every time you carry your  case on one shoulder, you are reinforcing this pattern.

Many musicians (violinists!!!) carry their instrument on one shoulder, and tend to favor the dominant, stronger, or non-injured shoulder.  The muscles on that side (if the load stays one shouldered) will elevate and contract, exaggerating the imbalance between the two sides as well as affect spine and pelvis alignment.  In addition, one shouldered bags affect your arm swing when walking and can encourage perpetual misalignment of the neck.  The heavier the bag or case, the more detrimental, especially if the strap gouges into your flesh.  This can aggravate the rotator cuff muscles, and if the carrying is combined with head forward position, can lead to future nerve impingements, thoracic outlet syndrome, etc.  Some people, who previously injured a shoulder or arm, tend to favor the other arm, which can then lead to a brand new injury-be careful and switch sides or use backpack straps!

See how this man's right shoulder is being pulled down with his bag?  In addition, his right arm is adjusting to carrying weight, and if he favors the right side only, may create a structural imbalance.  Moral of the story- switch sides!

See how this man's right shoulder is being pulled down with his bag?  In addition, his right arm is adjusting to carrying weight, and if he favors the right side only, may create a structural imbalance.  Moral of the story- switch sides!

If you carry your case in your hand regularly, be aware that your shoulder, scapula, and spine are being pulled down on that one side.  What that means is that you need to switch sides as much as possible to keep things balanced.  This also applies to celli and basses, who may pull or push their cases with one side repetitively, ignoring the other side of their bodies completely. 

Now that you know that carrying things can be precarious, ask yourself these questions:

Do I favor one shoulder or side over the other when carrying my case? 

Do I swing my case over one shoulder?

Do I always carry my case in the same way?

Do I always put one backpack strap on first? Or take it off first? (I.e., always put strap on the rightfirst, always take left off first)

Do I load down my case (or purse) with things I don't need?

Do I carry the same bag/tote/purse every day?

Does carrying my case sometimes cause pain?

No one body way of carrying is inherently wrong or pain-causing.  It's the frequency of repetition (and the overall weight) that can accelerate movement dysfunction.  Even if you don't have pain patterns caused by carrying your case, it's always a good idea to take a look at your habits, especially those that you take for granted, and see if they can be improved. 

*Last two images from Michael Pys "Posture Pain."

Pull your Cello Case (or Suitcase) Better

This image juxtaposes external shoulder rotation (left) with internal rotation (right).  Image from aafp.org

This image juxtaposes external shoulder rotation (left) with internal rotation (right).  Image from aafp.org

So I spent a little extra time in an airport yesterday, and in between walking laps for fun (when my flight was delayed), I watched people carry their belongings.  Some push their rolling suitcases, some drag their bags, some push on carts, and everything in between, but one thing that worries me is how your shoulder is involved to PULL a bag on wheels (This includes cello and other rolling objects).  Last month I covered how carrying things (cases, purses,etc,) affects us, so let's look at how pulling things can affect us.  Basically, you can pull with the palm of your hand facing forward (shoulder externally rotated) or thumb towards your hip, palm facing back (shoulder internally rotated).  

Now theoretically, all movements of the shoulder are valid, but given our habits of poor posture, and internally rotated shoulders, most of us should not be pulling weight in internal rotation.  Musicians already are prone to nerve impingement and other maladies, simply from overuse, misuse, and abuse, but we don't think about how we carry our instruments that often.  Pulling your case with your shoulder externally rotated is the most stable and supported position for the shoulder.  Period.  That means thumbs out to the sides, palms forward.    Sustained pulling in internal rotation, especially when coupled with misalignment and shoulder shrugging = possible pain in the shoulder and neck.  

Image of disembodied torso pulling a bag in EXTERNAL ROTATION courtesy of consumer reports.

Image of disembodied torso pulling a bag in EXTERNAL ROTATION courtesy of consumer reports.

It sounds super simple, but this above image shows a good way to pull a case, and the image below shows a less stable position.  I realize this is perhaps one of the least popular topics to discuss, but quite practical, seeing as most people in airports are juggling a suitcase, a cell phone, a small child, a purse, and a bag of food.   Trust me, you don't want to be googling the question "I hurt myself pulling a suitcase (or carrying a handbag). "   (There's not a lot of resources for that, by the way).    Notice that this couple, with their matching orange lego suitcases, have different pulling techniques.  The woman on the left is pulling in internal rotation, and the person on the right is pulling in external rotation.  They both have purses/crossbody bags, so  who's going to have a happier shoulder at the end of the travel day?  Person on the right, for the win!  Try both positions the next time you travel (or pull your case) and see how each positions affects your strength, your posture, and your ability to pull.

Image of matching suitcase people courtesy of me, following people in the airport.

Image of matching suitcase people courtesy of me, following people in the airport.

Still in Pain? Ditch the Heels and the Purse

Every once in a while, a musician friend will come to me in a panic because they have sudden shoulder, arm, neck, or back pain that's never been a problem before.  I usually ask them two (maybe three) questions: what sort of shoes do you wear, how big is your purse/case, and how do you sleep? If you're a regular reader of the blog, or if you know me personally, you know I don't like wearing high heels (or standing or walking in them) for long periods of time.  I frankly feel gypped- our society has told us that women look sexy, tall, powerful, etc., in heels, despite the fact that the shoes are killing our feet, knees, hips, back, and neck.  Any mainstream magazine will have articles for "comfortable heels" or "treatment after heels," but it wasn't until this year that I learned that elevated heel shoes are seriously contributing to your pain.  However, the combination of a heavy purse and heels is the real kicker.  Last week, I mentioned how carrying your instrument case can be a source of pain and misalignment, especially if you have a repetitive pattern of carrying that is never changed.  But let's take a quick look at purses and how they're really causing some pain.

For most people, it's not the style of purse that's the problem, it's how much it weighs and how you carry it.

For most people, it's not the style of purse that's the problem, it's how much it weighs and how you carry it.

There are a few different types of purses out there:

1.  The Over the Shoulder Holder

2. The handbag, which you must carry in hand or over the elbow.

3. The Big @$$ Tote, or the BAT

4. The Cross Body Bag (or a messenger bag)

Now quick, if you have a scale, go weigh your full purse, man bag, messenger bag, etc.  I'll wait.  Every once in a while, I weigh my purse, especially if I'm at an airport and they have one of those luggage scales, and it's disturbing how much we carry.  I've had bags weigh 10-20 lbs, and in school, my backpacks and messenger bags weighed 20-30 lbs.  Yikes!  Couple that with high heels, and no wonder people have back pain!

How high heels force a compensation pattern in the body- letter C is the control, and A,B, and D, are a few of the different ways your tissues might adapt.

How high heels force a compensation pattern in the body- letter C is the control, and A,B, and D, are a few of the different ways your tissues might adapt.

*Just in case you're wondering about my beef with high heels, take a moment to read these.*

Heels force the foot, knee, pelvis, spine, and neck out of alignment, and causing them to tuck their pelvis and jut the chest forward or round the spine, pushing the head forward.  Think of that as your starting position, and then add an 8 lb weigh on one shoulder when your body is already vulnerable.  Ouch!  If the head is in a forward position from heels (see images A, B, and D), and a one shouldered purse is added (and a case), the risk for injury is much greater, especially if you've already had neck, shoulder, or nerve pain in your life.

With our four types of bags, each poses a risk.  The over the shoulder bag tends to favor one shoulder all of the time.  Few people switch sides, which can pose a long term risk to those tissues, who remain on tension and in contraction which widens the asymmetry between the sides.  The handbag can be a great option if you carry it in your hands and don't rest it on your elbow constantly.  When heavy handbags dangle off the elbow, we put extra risk on the radial side of the forearm, specifically the delicate tendons and nerves.  The BAT is especially suspect because most of us (myself included) will fill that bag to the brim with things that we may not actually need.  If you need to carry lots of stuff, consider a messenger bag, a backpack, or carrying your tote in your hand to reduce the stress on your shoulders.  Lastly, the crossbody bag is a great option if you switch the sides with some frequency and keep the weigh in check. 

In the last year or two, I've moved away from carrying everything in my life on my shoulder (and ditched most of my heels...still have my cowboy boots, which have a half inch-1 inch heel), and my pain has diminished exponentially.  If this is something you've never thought of, stop walking in heels (and I don't just mean stilettos- I mean everything.  Take a ruler to your closet, folks!) and switch out your bag for something lighter.  Even if you don't have a scale in your house, look to see what you're carrying, and whether you need it.  If I'm honest, I don't need half of the things I used to carry, and I'm not in pain for it.



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