Musicians' Health Collective

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

Filtering by Tag: hips

Suzuki Turn-Out No More

Who decided that we should all stand with one foot forward and externally rotated?.jpg

     I started my humble music career as a Suzuki violinist, beginning at the age of 6.  While there are many useful and important things I learned in my early training, standing position was one that has posed confusion as I've aged.  Let me explain a bit more, for those non-violinist or violists out there.

This is a perfect example of learning "proper" violin stance.  Start with the feet together, then turn the feet out (externally rotating hopefully from the hip, hopefully) and then step the left foot forward.

This is a perfect example of learning "proper" violin stance.  Start with the feet together, then turn the feet out (externally rotating hopefully from the hip, hopefully) and then step the left foot forward.

When one learns beginning violin, often one is told to turn the feet out and step the left foot forward.  I learned this way, and stood this way for a long time.  (Over 15 years, at least).  A few years ago, I started noticing that in yoga, pilates, and weight training, we were told to have both feet pointing forward, at least sometimes.  I instead wondered, why do I always turn my feet out when I play, and does it actually serve me?  I have since started experimenting with this concept. 

This adorable image is from Shirley Givens' violin series, showing that left foot turnout.  In addition, the illustrated girl puts much more weight on her left foot, enhancing the asymmetry of the stance.

This adorable image is from Shirley Givens' violin series, showing that left foot turnout.  In addition, the illustrated girl puts much more weight on her left foot, enhancing the asymmetry of the stance.

So what's the big deal?  Our feet naturally point forward or with a minimal turnout, and you may already remember that when you walk with your feet extremely turned out, there are potential consequences for foot, knee, and hip issues.  (In addition, when feet point forward rather than externally rotated, the musculature of the foot is better able to support the body in standing and walking, and the ankle joint is able to articulate more fully.)  From a biomechanical perspective, I don't understand why music educators have been teaching students to externally rotate their hips while standing, and I definitely don't understand why one foot needs to be in front of the other.  I just don't.  (Who decided this was a good idea?)  However, I don't only care about the feet, but I care also about what is happening in the hips too.  When one hip is perpetually externally rotated (left hip), we can exaggerate that asymmetry out of the practice room, and in our daily walking, standing, and movement lives, even if we don't intend to.  That means that one set of external hip rotators is constantly working more than the other set, which can affect the muscles, bones, and connective tissue over time.  What does that mean? 

See how the right side is higher than the left?  Mine is the opposite-my left side is shorter than my right.  Pelvic tilt Image from http://medical-dictionary.thefreedictionary.com/

See how the right side is higher than the left?  Mine is the opposite-my left side is shorter than my right.  Pelvic tilt Image from http://medical-dictionary.thefreedictionary.com/

Side note, I came to this conclusion because of certain issues I was having in my hip, and that I was seeing in other colleagues of mine.  Here are some of my personal symptoms, which may or may not be yours:

1. My left hip has consistently turned out more than my right, whether I'm in music mode, standing, cooking, walking, running, etc. This can simply manifest as the foot turning out, at least in appearance. Both hips want to turn out in standing though.  I've been working on gently bringing the legs back to neutral, and found that to be helpful.

2.  This in turn can cause my left external rotators of the hip and the low back muscles to be unruly.  (Muscles include my gluteus medius, TFL, Quadratus lumborum, and the iliotibial band of fascia.

3.  I also have the beginnings of a baby bunion on my left foot which may be impacted by the external rotation of the hip.

4.  From a combination of asymmetrical music-making, left side dominance, and a host of other things, my entire left side is loads tighter (less range of motion from sole of the foot up to the shoulder!) than my right, which means that I sometimes have back pain and other issues on just the left side.  

So what's the solution?  Start to get curious. It's also important to remember that correlation does not imply causation- my left hip/back issues aren't inherently caused by the turn out, but I would venture to say that the perpetual external rotation has impacted things.  I will say that my pain has diminished exponentially since I've been doing pilates and other movement activities that have challenged my hip range of motion and stability.   

Ask yourself:

-How do you stand when you're playing? Where are your feet, knees, and pelvis?  What sort of shoes do you normally wear?  How might those be affecting your lower body?

-How do you teach your students to stand?  If you have a specific way of teaching stance, why do you teach what you do? 

-Try standing differently.  Maybe feet closer together, more parallel, right leg in front, both legs in the same orientation...give yourself permission to experiment, and perhaps that will change how you teach.

-Do you sit when you practice at home, and if so, what are your legs doing?

-If you photograph yourself (or video) while playing, what does your standing look like in context?

-Do your feet turn out when you walk/run/play/sit/etc?  Start experimenting with changing that setup gradually and see if it changes how you feel.  It can have ramifications all around the lower body, specifically feet/knees/hips/spine, but maybe affects other aspects as well.

Playing an instrument requires movement within the body- it's not meant to be a static endeavor, but repeating the same position in perpetuity for twenty plus years may not be the best.  

 

Running Recovery

This past weekend was one of the big marathons in my area, and watching people finish made me glad that I did not in fact participate, and more importantly, made me think of ways that runners might recover after such a race.  Here are a few of my favorite videos for self care after a race:

I love a little bit of rolling for center of glutes to prime your hips for daily life, but also to manage any overuse.

This is a video from friend and colleague Alexandra Ellis which goes through the 90/90 stretch, or the pinwheel hips of the mermaid in pilates.  It can be easy to neglect external and internal rotation when training for a race, and this is a good movement to add to the traditional work.

Lastly a quick calf roll out with a therapy ball, tennis ball, or softer ball can help restore foot and ankle movement.

Demystifying the Piriformis

Image from wikipedia- you can see that each hip rotator has a different angle of attachment from pelvis to thigh, but they work together as a team to externally rotate the hip.

Image from wikipedia- you can see that each hip rotator has a different angle of attachment from pelvis to thigh, but they work together as a team to externally rotate the hip.

One of the questions I get somewhat often is, "what is up with my piriformis, and why is it bothering me?...and will yoga fix it?"  Truthfully, I don't know what's going on for you, but let's look at where the muscle is, and what its function is.  One of the key things to remember is that this muscle, the piriformis, works in concert with the other deep rotators of the hip- lying beneath the gluteals, and working to externally rotate your hip and assist in abduction in hip flexion.  This group of muscles attaches around the sacrum (tailbone) and attaches to the greater trochanter of your thigh bone, so essentially from pelvis to leg bone.  The other muscles in that group (super and inferior gemellus, obturator internus and externus, and quadratus femoris) all play their own role in similar actions, yet the piriformis is the only muscle in that group that is directly in contact with the sciatic nerve, the largest nerve in the body running from the lower spine all the way to the foot.  

Many of us have heard of, or perhaps experienced sciatica, which can manifest as numbness, tingling, burning, or other sensations in the foot, calf, and thigh.  The cause of the sciatica can be more difficult to pinpoint- a lower back pathology may be the cause, such as a herniated lumbar disc, and although the lumbar nerves blend together around the piriformis, the hip rotators are not always, though sometimes, to blame.  Sciatica is not actually a clear diagnosis- it doesn't tell you what the problem is, just that the nerve is being compressed somewhere from the lumbar spine all the way down to the foot.  In most people, the piriformis is adjacent to the sciatic nerve, but in some people, the nerves actually pass through the piriformis itself, which is where the issues can present themselves in pirifiromis syndrome if the muscle impinges the nerve.  A nerve impingement could still happen elsewhere in the leg or spine, but usually the piriformis gets the bad rap for causing impingement of the sciatic nerve.  Side note, the research suggests that the piriformis is only responsible for 6% of sciatic pain!*

So then what do you do if you have sciatica or believe you have piriformis issues?  I'm a big fan of seeing a medical practitioner to make sure other issues aren't present, such as a spine pathology or something else. As a yoga/pilates teacher, I can't and shouldn't diagnosis the cause of the pain, which is why it's good to seek a medical professional's opinion.  But if you google "piriformis stretch," or "yoga for sciatica," you will see a plethora of suggestions.  My main hesitation is that sometimes, stretching an irritated muscle or nerve will make symptoms worse, especially if it's not the culprit.  Yoga poses also aren't pills to fix things- a greater awareness of what's going on in the body is critical!  One of the things that has become more commonplace knowledge is that if something hurts, stretching it is not always a good solution and that lack of strength and stability may also be the issue.  Some questions to ask yourselves if you are having sciatic nerve issues:

1) Are the symptoms present in both sides of the lower body?

Image from  Advanced Health Centers.  You can see the sciatic nerve branching out around the knee as it travels down to the foot.

Image from Advanced Health Centers. You can see the sciatic nerve branching out around the knee as it travels down to the foot.

2) When are the symptoms most present? (sitting vs standing vs lying down, etc)

3) Do any movements relieve the pain? (i.e. does walking change things)

4) Do any movements exacerbate the pain?

5) How many hours a day do you spend sitting in a chair?

Musicians (and normal people too) spend many, many hours a day sitting in a chair, often at 90 degrees of hip flexion.  Even if sciatica or piriformis issues aren't present, the continued static position of the hip affects the whole body, including standing, walking, and other daily activities.  Lack of hip range of motion coupled with lack of hip strength can lead to issues within the whole hip and spine complex, not just the piriformis, so start by asking yourself these questions about what's going on in the spine, hips, legs, and feet.  

*By the way, there's a great blog on the whole "yoga and sciatica" conversation, and it's definitely worth a read!  

Do Your Hips Extend? Looking at hip extension and flexion~

In a previous blog, I talked about the Psoas, a mysteriously named muscle with many functions including flexing one's hips.  Exactly what does that mean?

Hip flexion without bending the knee.

Hip flexion without bending the knee.

The word flexion actually means to decrease the angle between two bones at joint.  Flexing your biceps involves flexing your elbow joint, bringing the hand closer to the shoulder.  Thus hip flexion would be bringing the leg closer towards you in the sagittal plane (think plane dividing body into front half back half).

Now the catch with hip flexion is that most of us sit in chairs and end up in a position of passive hip flexion and knee flexion (bent knees) and retain that position for many hours a day.  We know now that our bodies process the movement or lack thereof and adapt to the shape that we most frequently inhabit, for better or worse.  If you primarily flex the hips and knees and never fully extend them, you may have chronically short or weak hamstrings, limited range of active hip flexion and limited range of active hip extension, for starters!

Pure hip extension!

Pure hip extension!

Extension (as a definition) increases the angle between the bones in a joint.  When you extend your knee, you are straightening your knee from the bent position, increasing the angle between the femur and the shin bones.  When you are extending your hip, your leg is essentially moving backwards in space, say 10-20 degrees.  When you walk, run, or lunge, you have one hip passing through extension.  Now why the fuss about these two words?

Standing apanasana can be great to focus on hip flexion (the bent knee) or hip extension (standing leg).  Try resting the bent knee on a table and stepping the standing leg back for more extension.

Standing apanasana can be great to focus on hip flexion (the bent knee) or hip extension (standing leg).  Try resting the bent knee on a table and stepping the standing leg back for more extension.

Well, most of us work the hip flexors (including the psoas and iliacus) most of the time- sitting, practicing while seated, cycling, driving...but only in a limited range, i.e. knees and hips bent to 90 degrees.  We need to balance out the movements of the hips a bit more- add more extension and more varieties of flexion.  For example, sitting cross legged, sitting on the floor, squatting, kneeling, etc. all require more varieties of hip movement.  To get more hip extension in your life, you can add some restorative exercises like standing apanasana, lunges (lots of lunges!) and go walk (not on a treadmill).  That way, you don't lose your capacity to move those joints to their full capacity, and you will have loaded the tissues in more diverse ways.

 

 

 

Even in great alignment, this double flexion of knees and hips starts to affect our soft tissues and our psoas, since that becomes our most frequent position!

Even in great alignment, this double flexion of knees and hips starts to affect our soft tissues and our psoas, since that becomes our most frequent position!

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