Musicians' Health Collective

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

Filtering by Tag: core

Adventures in the Respiratory Diaphragm

Up until this year, the respiratory diaphragm was a mysterious internal object.  I did know it existed, but the specifics were never really explained to me, and as a string player, breathing mechanics was never exactly emphasized.   However, no matter your instrument or occupation, your diaphragm is "arguable the most important muscle in your body.  If it ceases to function, you will expire."  (Jill Miller, the Roll Model).  What that means is that everyone should know that they have a diaphragm, and what it does.  (PS. For meat eaters, this is a skirt steak.  You can probably see why from the image). 

Last week, I talked about misnomers in response to the word core- think less 6 pack and more abdominal sleeving.  Now, I want you to add respiratory diaphragm to that definition of core.  It's your innermost core, and definitely worth talking about.  To get started, watch this quick video which gives some good definition. 

The diaphragm is a dome shaped muscle attaching to your lower six ribs, separating your organs from your heart and lungs.  On an inhale, your diaphragm contracts and basically acts as a suction to draw air into the lungs.  On an exhale, it relaxes and pushes air up and out.  (There's also a whole thing about pressured gases, O2 and CO2, but that's more science-y).  Most importantly, your diaphragm attaches to your ribs and your lumbar spine, which means that your day to day alignment, standing, sitting, and shoe choices not only affect your spine and pelvis, but your diaphragm and therefore, your capacity to breathe.  Let me repeat that with feeling: your poor posture, your high heels, your slumpy shoulders all = restriction in the respiratory diaphragm because they affect the position of the rib cage and spine.

In this extreme example of postural decline (and a dowagers hump), you can see how breathing mechanics would be completely distorted because of postural misalignment.  There's no way for the ribs to expand or the diaphragm to move much!

In this extreme example of postural decline (and a dowagers hump), you can see how breathing mechanics would be completely distorted because of postural misalignment.  There's no way for the ribs to expand or the diaphragm to move much!

Here is a fun fact: you take about 20,000 breaths a day, so why not bring some love to this amazing muscle?  When your diaphragm is not working properly, it can affect digestion, the pelvic floor muscles, circulation, and most obviously, your stress.  When discussing the autonomic nervous system in August, I mentioned how the breath is the most powerful way to gain control of fight of flight in performance.  (If you sing or play a wind/brass instrument, this is also essential to just play your instrument). 

To get started, what can you do about this?  Notice where you breathe-inflate the belly on the inhale, and see if you can spread the ribs apart, and then on exhale, belly pulls in, ribs together.  If you tend to breathe shallowly (either from asthma or stress patterns), see if you can deepen your breath by breathing down into your abdomen.  If you regularly wear elevated heel shoes, stop doing that and notice if you capacity to breathe changes.  And lastly, if you are a slumper, you are affecting your breathing by diminishing the diaphragm's ability to expand and contract by decreasing the space in the rib cage.


Your Core is Not Just Your Six Pack

Sometimes, if a friend or colleague has back pain aggravated by orchestra chairs, he or she will often say, "I need to work on my abs and core.  They're weak."  I'm always fascinated by this because for years and years, I was told by the media that core=abs, which in not actually the truth (or even close to the whole truth.)  So what is THE CORE?

Images like this make folks believe that core is just abdominals!

Images like this make folks believe that core is just abdominals!

Let’s start by redefining core by thinking, "your core is your center," AKA. anything above the pelvis and below the heart.  If you’re an apple, your core is the center of the apple. That includes the front, the sides and the back, folks.  The human body doesn't have much bone between ribs and pelvis because

  1. We need to put our organs somewhere

  2. We need to have an elastic space that allows from pregnancy and birth.

  3. We are dynamic movers, and having less bone allows more spinal and hip movement.

    Instead of bony structures around our belly button, we have a sleeve of muscle and soft tissue, with a bony supporting structure in the middle.  In that sense, core includes back muscles, erector spinae, obliques, transverse, rectus abdominus, your respiratory diaphragm and pelvic floor, and even serratus anterior, depending on who you ask. Many different fitness professionals, PT’s, trainers and other movement teachers will define the core in different ways, and decide which muscles qualify as core differently.   There are sometimes talk of slings, inner unit of core and outer unit of core, and more, but the main concept is that your core is not just your 6 pack muscles.

Most publications favor the front of the body when discussing core or abs, like this first image here.

Most publications favor the front of the body when discussing core or abs, like this first image here.

Let’s step back a bit though- why does your core matter?  Well, mainstream media pushes that flat abs, or six pack abs, or a flat stomach is, a strong core = flat abs=six pack.  Unfortunately, that's not true.  Visible abs is an aesthetic phenomena and not a functional strength one- the rectus abdominus is the most superficial ab muscle, and it often gets the most attention, but it's job is just to flex the spine, or fold in half.  Working on that muscle with a furious passion won't necessarily make abs more visible OR erase back pain.  Visible muscle tone of any muscle doesn’t indicate relative strength, efficiency, or lack of pain.

In the yoga, pilates, and fitness space, many of the cues that we receive about our core are confusing at best, with language like draw your navel in and up, draw your belly in, scoop your belly, and more. These cues in particular can often make folks squeeze their belly 24/7, or misunderstand the intention of the core to begin with.

One of the images that is used more frequently is thinking of the core as beverage can. If you squeeze your abs in and up, you are denting the can on one side, and also moving the contents of the beverage up and down (up into your diaphragm and down into your pelvic floor.) A more advantageous approach is learning how to stabilize your core without scooping, squeezing, or “navel to spine.” Dr. Stuart McGill purposes that individuals need to learn to brace or stabilize (when appropriate, not 24/7) and that some of our previous language about how to cue the core is ineffective and inappropriate.

Let’s recap:

First of all, visible abs don't necessarily equate strength in the midsection and back.  Even amongst female and male competitive athletes, abdominal tone ranges widely depending on genetics and individuality.

Secondly, your core is more than your abs. Your “core strength” is affected by your movement habits, and if you sit in a chair all day long, your body adapts.  Core strength is not just one’s ability to do crunches or roll-ups, it’s also our ability to stabilize in positions like planks, under weight, in squats or overhead, and more. Core strength is your ability to move from your center in a supported and balanced way, which includes standing, sitting, walking, running, playing your instrument, singing...all of it. Also start to notice if you randomly squeeze your abs to look a certain way or to “engage” your core. Do you bring your belly in and up every time someone tells you to engage or stabilize? That may not be helping you in the way you think it is!

Human Body Mythbusters: Musicians' Edition

So I'm sure I've ranted before that musicians should take anatomy/physiology classes and learn a bit more about self-care, but more importantly, let's look at some of the most frequent myths I get to bust in lessons, classes, friendly conversations, and emails. 

A lovely small image from Gray's Anatomy.

A lovely small image from Gray's Anatomy.

1. Your rotator cuff is one giant muscle, and you can tear it.  Well, yes, you can, but the rotator cuff actually refers to four muscles that assist in the movement of your arm and scapula.  If someone tells me they hurt their shoulder and "tore my rotator," I always ask them which one, which they inevitably can never answer. ( At least figure out what range of motion hurts, and then remember which muscle you hurt.  "Everything hurts" is not helpful.)

2. Your core refers to your abdominals exclusively.  I despite this misunderstanding, perpetuated by the fitness realm of "burn," "shred," "melt," and "tone," your abs.  Your core, refers to the entire muscular sheathing of your viscera and spine, which includes your abdominals (6 pack, obliques, transverse), back muscles, diaphraghm, psoas, and more, depending on your definition.  Some folks define core as include hip musculature too, so that's open for debate.  Either way, your 6 pack is not your core, although it is part of it, and doing sit-ups will not invariably cure back pain although strengthening the whole core might help.

Image courtesy of

Image courtesy of

3.  Your fingers start at your knuckles.  Nope.  While this is not intuitive, the bones that make up your metacarpals and phalanges originate at your wrist.  Your wrist position while playing your instrument directly affects your ability to use your fingers, and when you think of fingers articulating, they begin their articulation from the wrist.  In addition, your have minimal musculature in the hand, but instead the bulk of your musculature in your forearms.

4.  Your respiratory diaphraghm cannot be stretched.  So your diaphraghm is a muscle, which means that it can be tight, loose, weak, and strong, in various degrees.  Your diaphraghm is also a muscle nestled within your rib cage which helps your lungs to inflate and deflate. In addition, the muscles around your ribs can also be tight, loose, weak, and/or strong, which also affects your respiration.  There are interesting ways to stretch your diaphraghm (for another day-ooh la la!) as well as open up the muscles on the sides of the ribs, which can help your breathe more easily and more fully (good for most musicians and people at large).  PS.  The narrator in this video has a hilarious accent.

Amazing and interesting!

Amazing and interesting!

5.  The tongue is one big muscle.  Your tongue, ladies and gentleman, is a structure composed of eight separate muscles, attaching at various bones including the hyoid bone, mandible, and styoid process.  Without dwelling on the anatomy too much, take a look at this picture and be amazed!

6.  Standing with my feet turned out is natural.  Nope.  I've had a chat about this before, especially in relation to violin pedagogy, but here are a few thoughts.  Just because everyone does something, doesn't mean it's natural.  Everyone currently sits 6-8 hours a day, but that's not biologically natural.  Just because everyone turns out their feet doesn't mean that's natural either.  The more you turn out your feet and legs, the more likely you hyperextend your knees and flatten your pelvic/low back curves.  When your feet face parallel (or close), you walk in a manner that is more biomechanically sound for feet, knees, and hips, and can help change your pain patterning.

BONUS!  (Just thought of a few more to add as of 5 PM today.)

7. Sitting, standing, and playing with poor posture won't affect my long term body health.  Nope.  I've talked about this a lot, and I'm sure it gets boring to read about, but the way you move affects your tissues!

8.  Wearing High Heels Regularly Won't Affect My Body.  This is a biggie.  If you only wear them to sit in, then sure, you might be ok.  Walking and standing in them regularly will affect your alignment, your back, your knees, and possibly cause you bunions.  Save them for super special occasions and don't regularly concertize or audition in them.

9. Many of the great players had ridiculous setups and strange posture.  They didn't hurt -why can't I play that way?  In regards to string technique, much has changed in the last fifty years.  We no longer teach to learn how to play, but we teach folks (hopefully) in a way that not only imparts knowledge of how to play an instrument, but how to play it sustainably for a long time.  I can't know if famous musicians of the twentieth century were ever in physical pain from playing.  My guess is, yes, they were in pain sometimes, and no, there weren't an abundance of tools at their disposal for improving their setup.  My friend Molly Gebrian said this quite eloquently last week: "Great players played well not because of their (idiosyncratic) technique, but in spite of it."  That means you don't necessarily want or need the setup of famous 1940's violinists.

10.  If I just take an anti-inflammatory drug, all of my wrist/arm/shoulder/back pain will go away.  So if you just treat the symptom (pain/discomfort/tingling) and don't address the cause (misalignment, tension, overuse, too much playing, poor sleeping/standing/sitting alignment, etc.) the pain will most likely be chronic.  NSAID's can be important sometimes in treating serious inflammation and wounds, but we often medicate without thinking of the obvious thing: our body has an inflammatory response to treat tissue damage for a biological reason.  

"Overuse of the muscles causes cells to break down, releasing waste products, which produces pain and inflammation.  Cleanup crews in the form of white bloods cells called macrophages carry away the cellular debris. If you take anti-inflammatory drugs at this time, the natural inflammation process is disrupted and instead of being cleansed away in the blood stream, the trash settles into scar tissue." - Dr Emil Pascarelli

Maybe reconsider the next time you reach for the Advil, and instead ask, "why do I hurt?" and "Is there any other way I can treat this right now?"

While the body is a complex and interesting structure, many of our bodily misconceptions have affected how we play and how teach.  If one of these concepts resonated with you (pun intended), think of how it can help your students and your own practice!

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