Musicians' Health Collective

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

Filtering by Tag: forearms

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."

Flexors of the Wrist and Fingers

Another old school Gray's Anatomy picture, with the flexor digitorus profundum highlighted.

Another old school Gray's Anatomy picture, with the flexor digitorus profundum highlighted.

Sometimes, after a long day of practice or rehearsal, you can see musicians massaging their forearms and the muscles near the elbow.  Why?  Five key long flexors of the wrist and fingers originate in the elbow region, either at the bottom of the humerus or the ulna.  While their names are a mouthful, they are an essential part of how most of us make music every day!

Flexor Carpi Radialis: flexes the wrist

Palmaris Longus: flexes the wrist and helps flex the elbow

Flexor Carpi Ulnaris: flexes the wrist, adducts the wrist, and flexes the elbow

Flexor Digitorum Profundus: assists in flexing the wrist and and flexing second through fifth fingers, originates at the humerus (upper arm bone), radius, and ulna and attaches in the phalanges (in the fingers)

Flexor Digitorum Superficialis: flexes the second through fifth fingers and flexes the wrist, originates in the ulna and attaches in the fingers

Now, if none of that made sense to you, that's ok.  But you can probably tell that the big winners for musicians are these last two, the flexor digitorums.  No matter what your instrument is (sorry singers), your fingers bend to push keys, press the string, hold the stick, turn the page, or hold the baton.  Whether you have experienced tendonitis, nerve compression, or just feel tight after a long day or week of playing, tight flexors can definitely put an extra burden on your wrists and hands.  In addition, add to that poor posture while typing, texting, driving, biking, and anyone's wrists would be unhappy.  So what can we do about that right now?  Give it some love.

In addition to my rapid-fire photoshop painting skills, It turns out to be difficult to photograph one's own arm, fyi.

In addition to my rapid-fire photoshop painting skills, It turns out to be difficult to photograph one's own arm, fyi.

Exploring the Forearm Musculature

1. Place your hand around position one, or the border of your elbow.  You should feel muscle under there, and not pure bone.  Start to extend and flex and the hand and wrist being held, noticing the muscles that "jump" underneath your fingers.  The muscles on the top of the forearm, nearest the number one, are your extensors, and the muscles on the ulnar side are some of your wrist and finger flexors.  Maybe the flexors of your hand/wrist aren't as sensitivitve as your extensors- get curious!  Dig in and start to give yourself a little pressure point massage, especially if you find some tight areas of myofascial tissue.

2.  Using your thumb, start to make broad strokes in line with the fuschia lines, leading upwards towards the X.  If the skin crinkles under your pressure, even better!  Certain types of bodywork such as skin rolling, work to separate the most superficial tissue of the epidermis from the underlying superficial fascia.  It might feel a little weird, but give it a try.    If you find some especially tender spots, just press in with as firm or gentle a touch as you need.  Make sure to work on the far ulnar border of the forearm, near the number 2, since the pinky side of your hand works hard too!

3.  Stay away from the X.  That's your carpal tunnel, which is famous for carpal tunnel syndrome, but more importantly, where your flexor tendons (connecting muscle to bone!) pass through, as well as your median nerve.  You don't want nor need to "stretch" this area out, nor should you put direct pressure on it.  (PS. if you're tolerant of cadaver dissection, the wikipedia page has some human body pics on the bottom of this area.  Not really for the faint of heart, but super interesting.)

There are many, many, many more ways to access these flexors, and this is just the beginning.  (And don't forget to do both sides and notice the difference!)

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