Musicians' Health Collective

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

Filtering by Tag: head

Rethinking Headstand

image from Leslie Kaminoff's Yoga Anatomy.

image from Leslie Kaminoff's Yoga Anatomy.

The two yoga asana that are often touted as "the mother and father of yoga poses" are shoulderstand and the headstand, neither of which I teach.  You may remember my thoughts on shoulderstand risks for musicians, and  I thought it was time to tackle (and retackle) headstand and its risks (for musicians and normal folks too).  I used to practice headstand and it *always* flummoxed me.  I asked teachers about my alignment constantly, and yet I usually left class with a dull headache.  I stopped practicing it unless absolutely necessary (like when a teacher comes over to you and asks what's wrong with you and why you aren't doing a particular pose in class), and even then, have often put up a fight.  (PS. Any teacher, whether it be crossfit, yoga, Pilates, whatever, that doesn't respect your actual mechanical limits or your desire to perform a complex movement on any given day is probably not the right teacher for you).

Here are some of the health claims that headstand supposedly provides:

  • Builds strength in the shoulders, neck and core
  • Slows and reverses signs of aging
  • Stimulates the pituitary and pineal glands
  • Improves digestion
  • Calms the mind and relieves stress and mild depression
  • Relieves some symptoms of asthma, menopause, infertility, insomnia and sinusitis
  • Reverses the effects of gravity on the lungs, diaphragm and skin
BKS Iyengar in supported headstand.  Iyengar's teachings touted shoulderstand and headstand as the most important asanas, yet, they are precarious, and perhaps should not be held for as long a duration as has been taught in the last 50 or so years.

BKS Iyengar in supported headstand.  Iyengar's teachings touted shoulderstand and headstand as the most important asanas, yet, they are precarious, and perhaps should not be held for as long a duration as has been taught in the last 50 or so years.

-Courtesy of MyYogaOnline.com

And now a few (of many) risks: 

-Cervical vertebrae damage from an inability to support weight in shoulders

-Additional soft tissue/nerve damage (muscles, ligaments, etc.) to upper extremity

-Dangerous for those with high blood pressure who can experience ruptured blood vessels in the eyes and upper body

-Anti-inflammatory drugs  can add to risk

Courtesy of Performance Sports Care

Many of the supposed benefits may be true, but there's not much evidence based research out there.  I do have colleagues who believe to have injured themselves from this posture, and certain styles of yoga encourage students to hold this posture for 5-10 minutes daily.  More and more research based and anecdotal evidence is coming to light in regards to the hazards of headstand (and shoulderstand).

Here's a few reasons why I've never taught it in a group class:

1) First of all, it always gave me headaches.  Yup- It actually caused pain afterwards which usually subsided.  Why?  Because I found out two years ago that I have a pituitary tumor (non-cancerous), which means maybe I shouldn't put weight on my head like that.  No amount of "benefit" is worth that for me, even though it should balance the very system that I have a tumor on.  Did headstand cause my tumor?  Most unlikely.  Did headstand cause my headaches and occasional neck pain?  Most likely.  In a group movement class, you have NO idea what students are working with, and students may not themselves know what their limitations are.  I certainly didn't know I had a tumor, and other students may not know they have "forward head position," neck challenges, or that they lack the strength to support themselves.

Forearm balance- strength and range  needed before even thinking of headstand!

Forearm balance- strength and range needed before even thinking of headstand!

2) Headstand requires a huge amount of shoulder strength in external rotation, protraction, and upward rotation of the scapula to name a few.  A student would need to have impeccable alignment in forearm planks and dolphin, coupled with an ability to have stable shoulders in forearm balance before adding in a headstand.  In addition, some classes and styles of yoga have students hold this pose for 5-10 minutes in class.  We don't know what the long term damage can be to the neck and spine from holding a pose like this daily for that duration, so use your judgment!  

Lacking the range to attempt headstand or forearm stand.

Lacking the range to attempt headstand or forearm stand.

A starting range for attempting such postures- forearms can be parallel to the floor, shoulders protracted and supporting.

A starting range for attempting such postures- forearms can be parallel to the floor, shoulders protracted and supporting.

3) Not everyone has the range ability to get their arms over their head with elbows bent unloaded.  Take a look at these pictures below: see how the forearms aren't parallel to the ground in the first image?  If she then attempts a head stand or forearm stand, her body won't be able to get upright without some serious adjustments, possible with the neck taking too much load (poor delicate, highly mobile cervical vertebrae), her spine extending, or her shoulders getting shredded.  Before even considering head stand, a student should have the pure range of getting their forearms parallel to the ground in standing without compromising the spinal integrity.

This is a headstand adapter which takes the head and neck out of the equation.  I'd say that you still need shoulder strength, but it's a nice alternative for inversion junkies.

This is a headstand adapter which takes the head and neck out of the equation.  I'd say that you still need shoulder strength, but it's a nice alternative for inversion junkies.

4) Folks sometimes interpret headstand as time to jump on their head, literally.  Whereas you can kick into handstands relatively safely, headstand kicking up is a terrifying prospect.  Also, I hate being in a class where someone falls over backwards out of headstand-not only does it sound awful, it is painful.  (And never go upside down near a door, window, or an open flame, folks!).   In many ways, the foundations of handstands and forearm stands are much safer, both in terms of falling, and in terms of building long term strength for other poses and movements.  If you are determined to practice headstand, add in the piking piece to gain strength in the lower body, rather than hopping up!

5) We've built up a false history for headstand; most yoga asanas are not thousands of years old-most poses were "created" and codified in the last hundred years.  Attaching serious health and historical value to one or two poses (more than anything else) is  ridiculous and unfair to practitioners for whom this is not suitable and will never be suitable.  You can have a full beneficial yoga practice WITHOUT headstand, shoulderstand, or even downward dog!  This doesn't mean that you (or anyone) can't practice that pose anymore, but be aware of the inherent risks involved and notice when it is not well instructed in a group class setting (in which the teacher doesn't know every student's body, injuries, or abilities). 

If you're a teacher and you have the range and strength to perform the pose, you have to ask, "do all of my students understand what is needed here, do they have the pure range of motion, do they have the strength in their shoulders and serratus anterior, and can I instruct this in a way that everyone feels safe and supported?"  

This poor neck has taken a beating from constant neck flexion!  Keep your neck happy instead with gentler inversions!  Pic from  performancesport care.com

This poor neck has taken a beating from constant neck flexion!  Keep your neck happy instead with gentler inversions!  Pic from performancesport care.com

6) Lastly, many people have kyphotic standing and sitting posture, with necks a little forward and spine rounded.  If that already exists, why are you going to add 150-200 pounds of weight to it?  Even if the student is not misaligned in standing, headstand goes full throttle rather than gradually adding weight in the head and shoulders.  A hundred years ago or more, people (especially in India!) moved differently- they might have carried loads on their heads, they might have had better posture, they might have moved more, walked more, etc.  Nowadays, things are different-without head carrying, there's no pre-training of neck strengthening to even see if you can support any weight, let alone your whole body weight.  If you're a musician who plays an asymmetrical instrument, you're more at risk for one side of your neck to be tighter/stronger/weaker than the other side.  Combined with typical musician shoulder range and strength issues, poses that stress the neck should probably be avoided for many (many!) other more beneficial movements.

Last thing- if someone of something tells you that a movement you love is perhaps unsafe or not beneficial, rather than getting defensive, look at the big picture.  Why is this unsafe for you?  What restrictions do you have?  Do you lack strength or stability?  If you lack the range of motion in the shoulders or strength to support yourself in headstand, these are separate things that can be cultivated over time without doing the pose itself.  If your neck vertebrae are fragile from previous injury, then it may not be worth it to take a risk.  You only get one spine and one set of vertebrae (and discs!).  Rather than seeing the pose as the end goal, look at the movements and ranges required to execute the pose and then ask yourself: why am I so attached to this pose, and does it matter if I achieve it?  Doesn't any version or regression of the pose count as the pose?  Does it make you a better person, yogi, or teacher to do the "full pose?" ...Just my thoughts on that.

Copy of If you want to practice an advanced inversion like a yoga handstand, headstand, shoulder stand, or forearm stand, you have to ask yourself_ do I have the Range of Motion to perform this movement unloaded? Are.jpg

Guest Post: Flutists- Release Restrictive Patterns with Body Mapping

by Ruth Kasckow

Quite often flutists, and all musicians get stuck in a certain way of thinking that restricts their playing. When starting to play flute your instructor or your book probably taught you how to stand in the proper position, hold your arms up in the proper position, or blow into the flute with the proper embouchure. You were instructed how to tongue, breathe or move your fingers the proper way. These instructions, well-meaning and helpful at the time probably did not take two important things into consideration. Anatomy and movement. How are we actually structured and designed to move?

Can you treat your head balancing on your spine like a bobble-head, allowing for natural buoyancy and movement?

Can you treat your head balancing on your spine like a bobble-head, allowing for natural buoyancy and movement?

Getting stuck in a certain way of thinking can restrict your playing. For example, if you think there’s only one correct, proper way to stand, such as with your left foot forward and your right arm forward, you may think that you need to stand in that fixed position all the time. That in turn can create tension and limit your expression. That thinking is your body map. It is the body map or self-image you have that is telling your body how to move. The body map is powerful and almost always wins over the anatomical reality.

Inaccurate body maps - misconceptions about anatomy and movement, are common to all musicians. Flutists have their own set of inaccurate body maps common to many players that can cause problems. The good news is that inaccurate body maps can be changed with a clear understanding about the body’s true design. So even if you feel stuck by a self-image that is holding you back, you can do something about.

The junction between your skull and your spine is actually much higher than most people realize- if you stick your fingers in your ears, you're around the right height of the joint.

The junction between your skull and your spine is actually much higher than most people realize- if you stick your fingers in your ears, you're around the right height of the joint.

Here is one common misconception that might be familiar to you, and the anatomical reality that can help you get a clearer understanding to correct and refine your body map through body mapping.

Original instruction: “Hold your head up to play the flute.”

Flutist interpretation: “I need to hold my head up with my neck muscles while I’m playing my flute.”

Result: Tense and stiff neck, lack of movement in the jaw, lack of movement in the head, arms tense, breathing restricted.

Reality: The body is designed so that your head is balanced at a joint between the skull and top most vertebra called the atlas. This joint is called the atlanto-occipital joint, AO for short. The joint is located in the center of your skull at the level of your ear holes and top of your teeth-you can draw an imaginary circle around your head to get an idea. The actual movement is a tiny nod, like a bobble head doll.

bernienojaw-300x225.jpg

What to do: Explore the movement at the AO joint by first locating the joint with your fingers. Look at anatomy books, models, videos. Practice the gentle nodding movement. Observe how the gentle nodding movement can release your neck muscles, jaw, head movement, arms and breathing.

What you can expect: Less unnecessary work for your neck muscles, less tension in the jaw and easier tonguing, able to move your head easily to make adjustments for tone and pitch, arms are able to release and balance better over the torso, breathing is freer with less tension in the neck.

We all have body maps that can be changed. The process of body mapping is simply learning more about your body through observation, study and practice so you can become more kinesthetically aware. It’s possible to do it on your own, or with the help of a Licensed Andover Educator. Through conscious effort you can learn to play without being restricted by old thinking patterns that get in the way. In the process you’ll find a new sense of freedom in your playing.

Ruth Kasckow is a flutist, Andover Educator, and flute educator based in the greater Los Angeles area.  She has presented body mapping workshops throughout California as well as presented at PAMA (Performing Arts Medical Assoc) conferences.  To find more, go to www.flutemuse.com, and to learn more about body mapping and Andover Educators, go to www.bodymap.org





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Violinists and Violists: Your Chin Rest is Actually a Jaw Rest

I know, it's called a chin rest.  And the Kun thing is more of a collarbone rest, which is another misnomer for another day.  Today in my lesson with Alexander Technique teacher/bodymapper/violinist Jennifer Johnson, we talked about how the chin rest which should really be called a jaw rest.  When we hear chin rest, whether as an adult or child, we invariably think our chin goes on the rest, and we often turn our head extremely out to the left and press down with our head to "keep the violin up."

Using the chin rest as a point of contact with the "Chin" rather than allowing the back of the jawbone to make contact.

Using the chin rest as a point of contact with the "Chin" rather than allowing the back of the jawbone to make contact.

     When you look at Benedict Bones in the first image, you'll see that the portion of the body contacting the chin rest is the chin when the head turns out extremely to the left.  Few people have the violin or viola set up so that the head is in neutral and not turned out to the left, but notice how much you turn the head to the left.  Some students were told to look at their hands when first learning the instrument, but you can look without turning your head.  Others combine the head turn to the left with elevation of the scapula, which can lead to long term tension and discomfort.  Look at your setup or your student's: How much muscular work is happening in the back of the neck and the left side?  What's happening in your jaw?  Do you clench the jaw to hold the instrument up? Do you roll the head to the left or push the head down?

Image from Vital Gaitway, courtesy of Christine Altman

Image from Vital Gaitway, courtesy of Christine Altman

       I tend to agree with the image above, which shows the head in a pretty neutral position, bobbling from the AO joint rather than extremely turning the head to the left.  See the difference when the head is more neutral (image below)?  The jaw bone is in contact with the rest, rather than the chin.  Now you might say, "Oh, I'm going to drop it!"  First of all, the instrument is contacting many parts of your body besides your mandible.  Your hand is holding it, it's resting on the collarbone, it might contact your left neck, and your bow friction is helping matters too!  (Thanks to Jennifer Johnson's awesome book for listing those 5 places of contact).  We definitely don't want to push down or down and forward on the chin rest to hold the violin, so play around with positioning this week and start to notice where you contact your chin rest!

Notice that the back/side of your jawbone actually contacts the chin rest.  The chin is a layperson term which can also lead people to crazy head positions.

Notice that the back/side of your jawbone actually contacts the chin rest.  The chin is a layperson term which can also lead people to crazy head positions.

For the Musician Cyclists

This drawing from Carson Ellis (book is Wildwood) gives an idea of how we round our spines when we bike, especially if we have a road bike.

This drawing from Carson Ellis (book is Wildwood) gives an idea of how we round our spines when we bike, especially if we have a road bike.

Biking can be an amazing form of transportation, and just a great way to move without running or walking.  But doing anything in excess can change the soft tissue properties of the body.  Because of the rounded spine position needed, cycling and spinning compound many of the problems we see from sitting too much, including:

1. Tucked pelvis (posterior pelvic tuck)

2. Rounded upper spine

3. Head forward (check out my long blog on that issue)

That doesn't mean that you need to quit biking, but that you should incorporate some movement practices that do the opposite of this position.  I'm not necessarily advocating for yoga, since that's a whole other can of worms, but I'm advocating for a mobility practice that:

1. Brings the spine into extension

2. Loosens the tight muscles in the back of the neck

3. Explores range of motion for the hips

4. Opens the posterior muscles of the legs ( tight hamstrings and calves can exacerbate the pelvic tuck in walking, sitting, standing)

5.  Deepens a student's awareness of the body in space, and remembering how to return to neutral rather than rounded and collapsed off the bike.

This guy on the right is what I'm talking about.  Not looking great, especially with that wacky head position.  But, you can see how it's easy to bring that posture back from the bike and into the practice room, car, desk, or wherever.

This guy on the right is what I'm talking about.  Not looking great, especially with that wacky head position.  But, you can see how it's easy to bring that posture back from the bike and into the practice room, car, desk, or wherever.

Here are some other things to consider: biking can also tighten the muscles of your upper back and shoulders, and long-term, can decrease your mobility which is frustrating for musicians.  So do some shoulder work, keep working on hip mobility, roll on some balls, and pick your counter-activity carefully.  Every movement pattern we adopt affects the form and function of our body, long term, so make sure you're bringing your tissues back to neutral as you train, move, or just exercise.  

This blog is awesome for exploring biking postural positions.

Stretch out those in those shoulders here!

I like this YTU® pose for hips, and this video on the bottom for breaks in between biking, playing, driving, etc.

 

The Pain in Your Neck

Photo from Erik Dalton, PhD!

Photo from Erik Dalton, PhD!

Everywhere I go, I see people in pain, at least when it comes to their cervical vertebrae.  What am I talking about?  Texting head, turtle head, slumpy posture-there are any number of names for it, but the short form answer is that when your head is forward of your natural spinal carriage, you increase the amount of weight that your upper back, cervical vertebrae, and shoulders are supporting.   (PS. Your cervical vertebrae are your 7 vertebrae below the skull and above your thoracic vertebrae.  Think of them as your neck vertebrae.  They are built for mobility rather than stability in comparison to some of your other vertebrae).

Ok, so the head weighs 10-12 pounds, depending on who you ask, and frankly, how big their head is.  If we take this picture on the right, we see the natural curve of the spine on the far left.  The middle image shows a typical slump, and the increase in weight that the body is supporting is 20 lbs!!!  Then our man on the far right demonstrates the dowager's hump position, which means the upper back is supporting 30 extra pounds in order to accommodate your head.   Yikes!  And yet, many of us play our instruments in a head forward position.  I often see pianists, clarinetists, bassists, cellists, and even violinists in this position, which then reveals why so many of us have neck issues.  

Not only does this hurt the soft tissues of your upper back and neck, but it can create long lasting structural change in your bones, which you definitely don't want.   

Here are some suggestions: 

1.  Have someone take a side profile photo of you while sitting, standing, and playing an instrument.  Be objective and notice what your tendency is.  If you are prone to turtle head, don't try to just jam your head back into place, but slowly start to bring the back of your skull backwards in space, feeling both a backwards pull and an upward lengthening through the crown of the head.

This is a simple fav for the SternoCleido Mastoid (more on that another day) and general neck mobility. 

This is a simple fav for the SternoCleido Mastoid (more on that another day) and general neck mobility. 

2.  Make sure you do some simple neck stretches every day, especially if you are a one sided sleeper (!) or have chronic pain related to your instrument.  (Violinists and violists, I'm talking to you.)  You want to try to avoid excessive popping, snapping, and general "Rice Krispies" sounds in the joints, so move gingerly to stop.

3.  Set a timer while practicing to remind yourself to reset, stretch, and try to find a neutral neck position.  Consider some body awareness practices such as Feldenkrais and Alexander Technique to cultivate that proprioception.

4.  Be aware that pain below the neck due to misalignment, gait, knee pain, hip pain, etc., can absolutely be the primary cause of your neck discomfort.  Don't forget that elevated shoes of any sort can compromise your posture and put you in the head forward position!

5. If you're working with chronic pain, definitely see a medical professional.  You want to get checked up before you have disc pain, rupted discs, etc, and see a PT or restorative movement specialist to get resituated.

6.  Please, please, please do NOT do shoulderstand, plow, or headstand in a yoga class.  You can ask me why, but let's just say that for most people, it's not a great idea.  Be cautious about pilates ab exercises where you don't support your occipital ridge (aka. base of skull) with your hands.

Not just head forward, but whole body slump.  Ouch!

Not just head forward, but whole body slump.  Ouch!

7.  Pay attention to how you sit when you drive, type, etc.  Please also remember not to text and walk.  Not only is it super rude to the people around you (and you might get hit by a car*), it's walking in a slumped head forward position.  ouchies.

8.  Roll it out.  I'm sure you're detecting a theme here, but using small rubber balls along the base of the skull (occipital ridge) feels amazing, especially if you're working with some pain in that area, trying to change your alignment, or just feel tight. 

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