Musicians' Health Collective

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

Filtering by Tag: general wellness

Fascianating! What's the big deal with fascia, and should you blast it?

    I sometimes neglect a key part of understanding our body's soft tissues in an attempts to focus on muscle and function.  Which tissue am I referring to?  Fascia.  While you may not be familiar with the complex and interesting properties of fascia, you have certainly heard of it in terms of feet: plantar fascia, or the fascia of the thigh: tensor fascia latae.  Fascia is controversial, or as controversial as a soft bodily tissue can be.  Some scientists and researchers completely discredit its ability to affect mobility and muscle movement, whereas others are deeply entrenched in research on how it affects body motion and how it creates structure and form in the body.  I happen to be pro-fascia, if that's possible, and I do believe that certain philosophical tenets of fascia research are incredibly valuable to looking at the whole person in regards to tissue injuries and pain.  (As a reminder, I am neither a doctor nor a scientist, many of whom can more thoroughly explain these concepts.  This is merely my understanding as a musician and movement instructor.) Let's backtrack, though.

If we imagine that the peel is our most outer casing, we can see all of this white fibrous material which gives structure and organization to the fluid within.

If we imagine that the peel is our most outer casing, we can see all of this white fibrous material which gives structure and organization to the fluid within.

What is fascia?  Fascia is the soft tissue component of connective tissue (as opposed to nervous, muscular, and epithelial tissue)- there are many different types and textures of fasciae, from superficial to filmy to deep, interwoven around muscle and encasing organs.  Superficial fasciae surrounds all of our body much like a silk stocking, but tendons, ligaments, and even vertebral discs are considered part of the fascial system.  A great way of understanding this is looking at a grapefruit or an orange (thank you Tom Myers for the image).  The peel is akin to our skin and adipose layer, and when you remove it, there is an abundance of white pith, structural fibers, and casing around pockets of juice, AKA. the fruit.  Without the pith, there would just be a mess of juice inside the peel but with the pith, there is individual encasing and structure for the whole fruit, giving it a fibrous and juicy texture.  Over time, as the fruit ages, the pith and skin become less supple, and one may need to roll the fruit on a surface to restore some fluidity to the juice.  Most types of manual bodywork attempt to restore some of more fluid capacities of our fascial system, as we too are a fluid system (not fluid meaning like a waterbed, but fluid like a hydrated sponge).

Fascia is our body’s aqueous soft tissue scaffolding; It provides the matrix that your muscle cells can grow upon and it also envelopes, penetrates and surrounds all of your joints.
— Jill Miller
When you bisect the orange, you can see the geometric organization of the fibers, as well as the asymmetry and the random bulge in the right.  While we are not divide into segments like this, the structural binding is very similar.

When you bisect the orange, you can see the geometric organization of the fibers, as well as the asymmetry and the random bulge in the right.  While we are not divide into segments like this, the structural binding is very similar.

Why is this relevant?  Well, I have been absolutely guilty of exposing one or two muscles at a time, in conjunction with related bones as a way of demonstrating function and location, whether for blogs or for my yoga and pilates classes.  Yet, fascia underpins the entire structure of the body, meaning that no muscle, no movement, and no body part is an island.  While anatomy books may cut out everything but a deltoid to demonstrate certain aspects of its properties, the deltoid is truly part of a web of myofascial structures operating as a team, and in order to assess injury, limitation, and range of motion, one has to look at the whole body.  In addition, when your fascia is restrictive or your muscles are "tight" or perhaps lacking full range of motion (PS. "tightness" is an experience not a technical movement term), there can be an adhesion against the fibers, which can additionally cause discomfort and restriction in the area.

This is an image from Dr Jean-Claude Guimberteau's  Strolling Under the Skin , which takes a look at living human fascia!

This is an image from Dr Jean-Claude Guimberteau's Strolling Under the Skin, which takes a look at living human fascia!

As musicians, most of us assume an asymmetrical position to play our instruments (or sing, or type on the computer or drive or write), and our myofascial system adapts in accordance; something called adaptation, and sometimes adaptive shortening.  For example, as a violist, I have less range of motion in one of my shoulders from 24+ years of asymmetrical music making, but is it exclusively muscular shortening?  Definitely a combination of many different connective tissues adapting to the input I gave it, through the process of mechanotransduction!  While that is perhaps scary to think of, it also means that the body and brain are plastic, and that change is absolutely possible, both fascially and neurologically.  It also means that addressing the fascial system is KEY to healing from an injury, or simply improving performance.  

 

In Gil's talk, he discussed how fascia is stronger than we ever realized before, and that the health of the fascia profoundly affects the function of the structures it surrounds.  

In Gil's talk, he discussed how fascia is stronger than we ever realized before, and that the health of the fascia profoundly affects the function of the structures it surrounds.  

How is this different than other approaches?  Nowadays, Western medicine is focused on specialists-we have nerve specialists, hand specialists, orthopedic specialists, etc.  The catch, is that if you have nerve entrapment in the elbow, which affects your motion in your hand, you will be sent to all of these different specialists, without taking an integrated viewpoint of the big picture.  (i.e. you have may have nerve entrapment due to your motion patterns, as a result of injury to one shoulder, or to a poor setup in sitting with your instrument, or a compensation pattern, etc. etc.)  It can be incredibly frustrating to be in this situation, especially when no one can diagnose your ailment effectively, or when no one can treat your condition completely.  Many types of holistic practitioners, be they osteopaths, acupuncturists, physical therapists, chiropractors  etc, look at the whole picture of the body's wellness as a reflection of one area of sensation.  (Side note, holism is looking at integrated health, reductionism is the traditional western medical approach.  Both have their place, but many medical professionals are now looking beyond reductive means to find solutions).   This is in line with the idea that the whole body is fascially continuous, which means that an issue in the foot or ankle can affect the hip, knee, or spine, but not just on a muscular or neurological level.

Image courtesy of AnatomyTrains.com.  The first image questions the dissect and separate logic of traditional study, and the second explores the more integrated idea of fascial webbing.

Image courtesy of AnatomyTrains.com.  The first image questions the dissect and separate logic of traditional study, and the second explores the more integrated idea of fascial webbing.

I'm still confused.  How does this affect me again?  Many injuries start with the health of our fascia, the hydration level of the tissue, and the ability of the layers of myofascia to slide and glide against each other.  When our fascia is dried out or brittle, we are at higher risk for injury, and our capacity for proprioception, or bodily awareness is diminished. *An article by Tom Myers of Anatomy Trains proposed that there are 10 TIMES more proprioceptors in fascia than in muscles!  As musicians and movers, proprioception is our portal to movement quality, movement efficiency, and increased performance, whether in daily activities, musical activities, or athletic performance.  Your movement choices, or lack thereof affect your fascia profoundly!  Also, scientists are discovering that fascia is significantly stronger, more malleable, and impactful than ever thought before- it used to be something discarded in dissections, and it's way more than that.  It affects the muscle system more than we realize!

The Fascia-Blaster.

The Fascia-Blaster.

Healthy fascia benefits from diverse, varied, and frequent movement, as well as manual therapy (or tool assisted therapy).    A bodyworker can also help to expose issues in your myofascial web (myofascial meaning muscle+fascia), whether that be through myofascial release, rolfing, etc. 

Should I be blasting my fascia? Ugh...well, I'm glad that the fascia- blaster made the word fascia mainstream, but I'm pretty against the fascia blaster.  In case you don't know, the fascia-blaster is a "tool" that attempts to rid the body of cellulite via a hard plastic self inflicted torture device.  The first part I dislike about the fascia blaster is that it demonizes fat and cellulite, which isn't helpful.  It makes money by shaming people (often female identifying) about their bodies.  Your fat layer is your superficial fascial layer, and yes you can change it based on diet, exercise, etc., but there's nothing wrong with having one to begin with, and the goal is not to get rid of all your fascia or superficial fat.  I always bristle at schemes intended to have dramatic before and after images, and to say "thin is better than whatever you are now."  Oh, and don't forget that the product can cause bruising and other severe reactions- yes, your cellulite will be gone if you bruise it up, but it will probably return once those bruises heal.  Don't worry, I had a thigh master in the 90's and an ab roller as a teenager, so I've tried that seen on TV $#*%.  The founder of the implement doesn't have any professional training as a medical professional, bodyworker, or movement trainer (or at least none of her credentials are listed...anywhere).  At the end of the day, I'm just sad that people are beating themselves up with a hard plastic implement that causes bruising because of cosmetic reasons.  (Softer stress transfer mediums are great- not lacrosse balls or blasters, but softer balls, squishy balls, rubber balls, etc.)  Love your fascia, treat it kindly, and it will move you well.

I had the opportunity to hear Gil Hedley in Austin, and he dropped some excellent truth bombs about fascia.

I had the opportunity to hear Gil Hedley in Austin, and he dropped some excellent truth bombs about fascia.

Want to know more?  I'll definitely post more on fascia in the future, but some of the leading scholars in fascia are Robert SchleipTom Myers of Anatomy Trains and Gil Hedley of Somanauts.  I also really like Brooke Thomas' blog, The Liberated Body, and her respective Ebook.

Move More, Sit Less

If you read fitness and wellness articles as much as I do, you'll notice there's a new trend, with sensationalist headlines like:

Image and article from the August 2013 issue of Runner's World.  I don't necessarily know if sitting is the new smoking (I think high heels win for that title), but we could definitely do with sitting less often.

Image and article from the August 2013 issue of Runner's World.  I don't necessarily know if sitting is the new smoking (I think high heels win for that title), but we could definitely do with sitting less often.

"Sitting is the New Smoking"

Sitting Is Bad for You. So I Stopped. For a Whole Month.

Are You STILL Sitting?

And of course, Why Sitting Is Killing You

So what's the problem here?  Why all the fuss about sitting?  If you do your 45 minute workout and then sit at work (teaching, orchestra, etc.), then aren't you following healthy movement protocol?  Not so much, actually. 

First of all, sitting all day, standing all day, walking all day... any perpetual action isn't inherently good or bad-It's the quality of movement plus the elapsed time spent in that activity.  If you walk and stand a lot, but wear poor shoes and have dubious movement patterning, then you could easily be in pain.  (Hello waitressing, customer service, retail, nursing, and teaching !)  With sitting, most of us sit on our sacrums instead of our sitz bones (which by now, you have seen discussed frequently, from sitting for children to sitting on a bike...) and then we sit for 8-10 hours a day.  (Drive to work, sit to bike, sit to play, sit to eat, sit to hang out with friends, sit to type, write, etc.)   Try Katy Bowman's How Much Do I Sit Quiz for a good reality check on how much you're actually sitting.

So back to the task at hand.  What are some of the consequences of perpetual sitting?

Sitting looks pretty scary, eh?

Sitting looks pretty scary, eh?

1.  Musculoskeletal problems from poor alignment.  Ahh, repetitive stress injury, I know thee well.  We've mentioned some of these issues already, but here  are a few of these again:

Head Forward yielding Neck Issues

Sitting on the Sacrum and Not the Ischial Tuberosities

Slump in the Upper Body (excessive spinal flexion)

Let's not forget that our muscles and bones respond to the stress we put on them, so the musculature of your hips, back, core, shoulders, etc., will start to lose mobility if you're constantly sitting, especially in poor alignment.  Remember, when you bring these issues to your normal seated position, they follow you when you play in orchestra, chamber music, recitals, driving, etc.  They're a real pain (pun intended).

2.  Cardiovascular Issues.  Katy Bowman's blog is great for explaining this in more detail than I can, but short form summary, even if you lower your cholesterol and you "exercise" every day for an hour, you can't undo the effects of sitting.  Your blood cells pass through your arteries, hopefully smoothly, but sitting creates more of a maze like structure for cells to pass through.  It's like an obstacle course for your blood cells, and if you've already got thickened arteries from genetics and other factors, your body is more at risk for cardiovascular issues.  (She explains this so much better than I do because she is a science-y lady, not a violist.)  This makes sense though-you can be an ultra marathoner on the weekends and still have heart disease, even if you have high intensity workouts planned frequently. 

"You can’t undo 8 hours of wounding with a run or with bigger muscles. Fitness doesn’t touch the wound that has been created." - Katy Bowman

3.  There are various other studies that link computer use and sitting with an all over decrease in movement, which affects weight, lymphatic flow, blood flow, muscle strength, etc, and frankly, science hasn't made an all encompassing statement on all the bad things that happen to you when you sit all the time.  I think we can all agree that we should sit less though.

Ok.  So now what?  If you're a cellist or pianist, you're logging some serious sitting time, i.e., 8-10 hours a day sometimes, if you practice, teach, rehearse, drive, bike, and type.  That's more than most of us sleep, which is distressing.  Rather than try to undo that with intense cardio or weightlifting, let's move more.  Walk more often.  Take breaks and stretch every half hour or so.  Have meetings while walking.  Stand while typing.  Pay attention to how you sit in the car.  Make phone calls while walking rather than while sitting. 

More on that next time, but start noticing how much you sit every day.  Seriously. 






Travel Tips

Last year, I flew over 65,000 miles, including three cross-continental journeys, which to me, is a lot.  In the process of doing so, I've established a bit of a routine in preparing for flights and long trips which has been quite helpful.

1. Bring your own food, especially if you have dietary restrictions or preferences.  Nothing is worse than being rushed in a connecting flight and hungry and vegan/gluten-free/paleo.  Most airplane food is carb and sugar heavy, which means that you don't feel particularly full, or particularly good afterwards.  I bring those little nut butter packets, some Kind bars, some fruit, or hard boiled eggs to fill in the gaps.

image.jpg

2.  Bring some hand sanitizer, preferably one that smells good.  I have never seen the fold down tables or arm rests cleaned in an airplane, so I'm going on good faith that someone at sometime during the day cleans them...

3.  Don't drink a lot of caffeine, even if you have a 6:00 AM flight.  Not only will coffee make you jittery and dehydrated, it usually isn't very good on an airplane.  I usually bring some teabags and ask for hot water on the plane, just so I don't end up having a Lipton Landing experience.  (Or I just drink water).  That way, I can have at least a fighting chance of sleeping on the plane or at my final destination.

4.  If you've been feeling tired and weak, bring some emergen-c or something similar.  Nothing is worse than traveling for a concert or audition and feel mid-flight that the plague has stricken you.  Emergen-c might not prevent a full-out affliction, but it might delay the effects and make you a little happier for the flight.  In addition, always pack a basic first aid kit-Benadryl, cold meds, Advil, etc.

5.  Try to be nice and patient.  Airports, much like the DMV, bring out people's unsavory sides.  I often see folks snapping at flight attendants over not having their beverage of choice, and small children mowing down the elderly to get to the bathroom.  Musicians tend to panic a bit about getting their instruments unboard (for good reason!), but patience, calmness, and kindness, will probably serve you better in the long run than yelling about the cost of your instrument to an airport employee who is being unhelpful.

6.  Bring your music in your carry-on or case. Sometimes, you just don't want to risk having things lost.

7.  When people ask if your viola/violin is a banjo/ukelele/bass, try to be nice, even if the question is absurd.  The airport, much like the subway, is a fishbowl, and not everyone will be have musical knowledge.  You may end up having an interesting conversation, but most likely, you'll just hear how the passenger played kazoo/sitar/euphonium in middle school.  (Although I did have a family that thought my dog was a rabbit, even though they could see her chihuahua face, so...use your judgment). 

8.  Try not to sit in a chair in the waiting area.  Your whole day will be sitting (or really, slouching) in a big chair.  Stand!  Sit on the floor and wake up those hips! Squat by the electrical outlets!  Creating some movement pre-flight will definitely help your spine and hips to be happy.  When I have a long flight, I often hide in a less popular area of the airport and stretch it out.  Even better, if you're not lugging a lot of luggage or a cello, try to walk in the airport as much as time allows.

9.  Keep limber on the plane!  See here for thoughts beyond those weird pics in the back of the plane magazine.

10.  Bring things to read.  Bring earplugs for international flights.  Get one of those weird neck pillows if you're on a long flight.  Bring headphones, and maybe a hairbrush.  (I've forgotten all of these things at some point.)  Make sure your bags have your name on them.  And lastly, have fun on your trip, whether it be for an audition, concerts, festivals, weddings, or family time.

Here are some more suggestions from the internet:

Katy Says: Travel Notes

How Stance Affects Posture

As much as I've avoided the prospect of making a video of myself talking, the time has come in which my verbal explanations of things are not cutting it.  In this video, I go through four of the common violin/instrumental stances and how they affect the hips and upper body.

     A few notes- I've exaggerated some of the movements just to get the point across.   In addition, the pelvis is sort of like Grand Central Station-it's a point of structural and muscular connection between your lower body and your upper body.  The tilt of the pelvis affects everything above it, and the way you place your feet underneath the knees affects the pelvis.  Thus foot position affects the entire spinal column.  As a human being, you want to have the ability to turn your foot (hips!) inwards and outwards- this is important movement to maintain!  The externally rotated position itself isn't purely "bad" or "good," but isn't great for consistent standing and walking, as it will begin to affect the spine, gait, knees, etc., and if done asymmetrically, will have huge repercussions for the body.

  Which are your most common positions, even if you sit while playing?  Which foot do you favor? 

Beginning Self-Inquiry of Movement

by Andrea Kleesattel

      As musicians, we are constantly working with the limitations of our own physical and mental self-control.  Whether we are trying to coordinate our body movements, trying to increase our ability to focus, or dealing with the anxiety of performance, we are always trying to extend our capabilities and self-awareness.  We seek to become more than we are.  

      However, over the course of living and playing an instrument for years, we all naturally establish habits.  Some of these are intentional but others, many others, exist without our even knowing that they are there and can be damaging and limiting.    

      In order to break out of these habits we must exercise our self-awareness and ability to change.  The more we come to know ourselves and the more adept we are at trying and assimilating new ideas, the easier it will be to learn new ways of playing that might be more efficient than the ones we are currently employing.  In so doing, we can mitigate unnecessary stress on the body and hopefully save ourselves from injury, while at the same time opening ourselves to greater spontaneity and more choices for artistic expression.

We carry many movement habits with us, known and unknown, especially in the act of making music.

We carry many movement habits with us, known and unknown, especially in the act of making music.

      One method that can be helpful in this process is the Feldenkrais Method, which exists in two different formats:  Awareness Through Movement and Functional Integration.  In Awareness Through Movement, students are verbally guided through a series of slow movements which help them to increase awareness of their body and its integration.  In Functional Integration, students work in a one-on-one session with a Feldenkrais practitioner who uses touch to help guide the body towards greater integrative awareness.   (Awareness Through Movement lessons are available commercially in CD and DVD formats.  One can also find a local Feldenkrais practitioner for Functional Integration lessons as well.)

      Through moving slowly, it becomes possible to redirect a movement before it happens automatically.  We can open a space in our actions that used to be closed to our awareness, allowing it to come within the sphere of our self-control.  In the process, we can cultivate greater awareness of the body.  Through these sessions, students become more aware of how the parts of the body work together as an integrated whole.  And through this awareness, students can begin to move more efficiently and create more options for the movements they make.

Which shoe do you put on first?  Which foot/leg is dominant in walking?

Which shoe do you put on first?  Which foot/leg is dominant in walking?


      You can start to exercise some of the Feldenkrais principles before you purchase a CD or find a teacher simply by observing your habits and slowly (and patiently) starting to change them.  You can do this for everyday actions.  Find a habit that you have in everyday life.  Which tooth do you first start brushing?  When you get dressed, which leg do you first put in your pants?   How do you habitually cross your fingers?  Is the right or the left thumb on top?  How do you cross your legs when you sit cross-legged on the floor?  Is there a specific way that you open your instrument case and take out your instrument?  What is the first thing you do when you sit down to play?  Think of any habit that you have. First see if you can observe it in the context in which it occurs.  Next, see if you can stop yourself before you perform the habit and try doing it in a different way.  

      Try doing this for your playing.  Are there certain physical habits that you have when you play that are independent of your playing?  Perhaps you raise your eyebrows or close your eyes when you are doing something that is difficult.  Perhaps your foot tenses in certain places, or you move your body in a certain pattern.  Go slowly.  Before you perform the habit, stop yourself and try something new in its place.  Have a friend watch you as an outside observer.  As you practice non-habitual behavior in place of the habits you have identified, see if other habits become more noticeable to you and easier to change.

      You can also ask yourself questions about your body posture and usage.  How does the position of your hips effect your neck and shoulders?  If you put your weight on the front part of the pelvis while you are sitting on a chair, what does this do to the spine?  How does this change if you move your weight to the back part of the pelvis?  How is the body affected if you put the majority of your weight on one sitz bone or the other?

      You can try these things with or without your instrument and can try them in different patterns or in isolation.  Be curious, inventive, and playful in your exploration.  Play lying down, or standing on one foot, or looking at the ceiling, and see how this changes things.  Even if you don’t know what changes or how it is different, don’t be afraid to keep looking and asking.  It’s not the answer, but what we learn in the search and the process.

      We will always come up against the limitations of our own self-knowledge.  There is no end to it.  But we can become more and more comfortable with ourselves the more we seek and explore, and this can bring us closer and closer to the full self-expression that we desire.  It is a process to be enjoyed. 

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