Musicians' Health Collective

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

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Rib Flare, or Where Are Your Ribs in Relationship to the Rest of You?

Sometimes at social gatherings, people will ask me to fix their posture, AKA. "Tell Us what we're doing wrong, right now!"  This is what I tried to tell them, albeit only somewhat successfully.

As musicians, movers, and teachers, most of us have been taught "good posture" markers, like sit/strand up straight, shoulders back, head upright, suck in the belly.  Ironically, many of these cues will not yield good posture at all, but will hide the body's deficiencies through overcorrection.  For most of us, this was continue out into our daily activities, including yoga, weight lifting, running, etc. and yields rib thrust or rib flare.  What is this, you ask?  Take a look at this image below of Katy Bowman, biomechanics movement goddess. 

Image from  Nutritious Movement .  Go read her books now.  I'll wait.

Image from Nutritious Movement.  Go read her books now.  I'll wait.

Take a look at the three difference variations of posture (there are infinite variations- these are just a few).  Which one looks "the best" to you?  Number three?- in which the body is upright and the shoulders back?  Or Number Two, in which the spine looks slightly rounded or kyphotic?  Also look at the vertical plumb line between the three images- only number two has the head stacked over the heels.  In both image one and three, the head is trailing forward of the heels.   Which image do you most resemble?  The "best aligned" posture of these three is not number three, but number two, in which the body's natural spinal curves are preserved, and the head, ribs, and pelvis are all in a unified line.  Number three reveals the rib thrust, which can be defined as the ribs moving forward of the pelvis which then does gnarly things to the lumbar (low back) spinal vertebrae.  This is separating an aesthetic marker (shoulders back, chest forward) from a true body alignment marker (ribs and head over hips and heels).

Time out: What are forces? Has it been awhile since you studied physics? (For me, over a decade, so force = mass x acceleration) Fear not- gravity (a force) is still working with you. There are other forces (non Star Wars related) working on you as well in movement, including tension, compression, shear, and torsion. Go read about them here!

Image from  Leslie McNabb.

Image from Leslie McNabb.

So even if this whole force thing isn't making sense, you can see that the ribs are shifting forward of the pelvis, right?  What that does is compress the lower vertebrae, as well as make for some unhappy soft tissues, a dysfunctional core (can lead to diastasis recti, especially when pregnancy and post  natal issues are coming up ), and a possibly dysfunctional pelvic floor (incontinence, pain, etc.) amongst other things.   (See this woman on the right?  Does she have "good posture" or is she just masking her body's dysfunction by pushing her ribs forward and throwing her shoulders back?

Most of us have some degree of rib thrust, but it will manifest more often when wearing high heels, because the body is trying to mask the inherent distortion that high heels creates for the spine.  (Gentlemen, most likely your dress shoes have a heel, so you are not immune to this conversation)

Bad posture to bad posture- not bad to good!  Image on left shows the over-rounding, or kyphosis of the upper back with the pelvis forward of the heels, image on right shows rib thrust, to appear to have "good posture."

Bad posture to bad posture- not bad to good!  Image on left shows the over-rounding, or kyphosis of the upper back with the pelvis forward of the heels, image on right shows rib thrust, to appear to have "good posture."

Let's review- in the rib thrust, the bottom most ribs are shifting forward of the pelvis, which draws the scapula back and creates the illusion of good posture (upright body, broad collarbones).  It is in fact masking the issues at hand, which are lack of mobility in the thoracic spine, and possibly hyper-kyphosis, as seen in the image on the right.  So what can we do about the over-slump?  Start to work on thoracic mobility, shoulder mobility (with stable ribs), and keeping the bottom-most ribs down.  

So first, do some exploration, and see where you fall in the spectrum- where are your ribs hanging out?

Here's some more reading about rib thrusting!

"R U A Rib-Thruster" by Katy Bowman

"When Good Posture is Actually Bad for You" by Leslie McNabb

"When Is a Backbend Not a Backbend?" by Jenni Rawlings

Detangling the Pecs: Part 3

Image from  Erik Dalton

Image from Erik Dalton

This week, we've looked a little at what the pectoral muscles do, specifically the pec minor, and how restriction with the front of the chest muscles can bring the shoulders protracted and internally rotated.  Now, how can we start to create change within those muscle groups to better balance out the shoulder joint?

1) Address the restriction on the front via awareness: is it a result of your instrument? Your sitting habits? Your driving habits? Do you notice your shoulders slumping forwards in daily activities?

2) Correction with outside feedback: It can be tempting to just think "I need to bring my shoulders back and down," but that's not helpful either.  The shoulder joint is highly mobile, and even though restriction in the front may be an issue, there may be other culprits that could use attention, whether it's in the neck, the spine, or the shoulders themselves. In addition, a shoulder blade moving forward, or protracting, may also be internally rotating. (see video below)  I'd recommend seeing some sort of movement professional (PT, massage therapist, pilates teacher, trainer, body mapper, Alexander Technique teacher, etc.) and ask for some feedback.  (As always, if you're in a place of acute pain, see a doctor for a full assessment!) Although I primarily teach pilates and Yoga Tune Up®, there are many well educated movement professionals in different fields that can help you identify your issues.  One thing I find helpful is to take pictures on a phone of your shoulders/collarbones, and just use those as a reference as you start to make changes.

The infraspinatus and trees minor are key muscles to look at strengthening.

The infraspinatus and trees minor are key muscles to look at strengthening.

3) Mobilize and Work to strengthen your external rotators of your shoulder: So for every muscle group that contracts, there is an opposing muscle group that's relaxing.  The muscles on the back of the shoulder blade are primary external rotators of the shoulder, and can help bring the arm bone back and done, but without forcing it in an inorganic way.  How does one strengthen these muscles? Most movement disciplines have some form of strengthening built in of these muscle groups, but here are some of my favorites:

This may seem really easy, but if the spine and ribs are stable, and the arm bone not moving forwards or backwards, it can be a real challenge.

This may seem really easy, but if the spine and ribs are stable, and the arm bone not moving forwards or backwards, it can be a real challenge.

1) This classic strengthening exercise involves either a theraband or a set of small hand weights (like the dinky vinyl coated ones).  One can do it standing or side lying, but essentially, the goal is to keep the upper arm bones, or humerii, stable as you pulse the hands away from the body.  This video shows how to do the same exercise in standing, with a theraband.  One can also do it in standing without any resistance.

2) Reassess your plank poses, downward dogs, or even quadruped/ hands knee poses.  Many times I see students in internal rotation from the onset of class, and learning how to externally rotate the arms in weight bearing positions in critical, especially if you practice weight bearing positions.  One of my favorite Jill Miller videos is about the challenges of downward dog for the shoulder.  If you're a yoga student, this video is a must!  Here are a few other blogs about the challenges of Downward Facing Dog.

3) Look at where you may be missing range of motion in your shoulders: I love shoulder flossing, either with a theraband, Fletcher Pilates towel, yoga strap, or other device.  This great video by Christine Jablonski shows one of my favorite Yoga Tune Up® exercises.  Although this isn't a particular strengthening exercise, it can help bring awareness to where you need mobility in the shoulder.

4) Bring some length to the front of the chest via floor angels.  This is one of my favorite exercises, and it can be down with the upper half of the body on a foam roller or bolster or block.  The number one objective is to keep the ribs down (which the woman on the right is NOT doing) to really assess where your actual range of motion is. Once the spine starts moving, you've lost the intention of the exercise.  This is a classical Katy Bowman exercise, but this video  also describes it well.

Although there are many ways to strengthen the shoulder and start to bring change into the shoulder joint, here are a just a few ways to get started~

"You Are How You Move" : A Crash Course in Mechanotransduction

This comic from  Bliss  demonstrates mechanotransduction in action- our day to day movements affect our body!  How does your cell phone/ipad/screen time affect your head and neck?

This comic from Bliss demonstrates mechanotransduction in action- our day to day movements affect our body!  How does your cell phone/ipad/screen time affect your head and neck?

As I move into the second year of coursework for my training with Katy Bowman, I thought it might be nice to address an issue that I've alluded to but not directly written about: mechanotransduction.  As words go, it may not be familiar, but as a concept, you will certainly understand it.  We all know on some level that the way we "exercise" affects the shape and function of our bodies, but mechanotransduction refers to the "the conversion of movement input to biochemical processes" (Move Your DNA, pg 10).  All of your movement choices, i.e., shoes, walking, how you sit, how you play an instrument, how you stand, how you exercise...these are cellular inputs into the body, meaning that your body is constantly responding and adapting to this information on a cellular level.  We know some of this from experience- sitting casts our body in certain shapes and habits, whether or not we intend them.  So does playing an instrument, wearing high heels, wearing misfitting shoes, constantly leaning to one side, and so forth.  We usually think of this in regards to exercise, which for most people is 5 hours a week of intense vigorous activity, compared to 107 other hours a week that people are often stationary.  (Assuming average person sleeps 8 hours a day and is doing things the other 16 hours a day, times 7, minus 5).  Yet, what about those other 100 plus hours a week of movement or lack thereof?  It's important to not just look at exercise, but look at one's whole week of movement to see what habits lie within.

The way we hold our instruments causes constant adaptation in our bodies.  A lifetime of poor neck positions may result in undesirable structural adaptations!

The way we hold our instruments causes constant adaptation in our bodies.  A lifetime of poor neck positions may result in undesirable structural adaptations!

Katy Bowman discusses all of this eloquently and efficiently in her book, Move Your DNA, and really delves into loads, but here are some of the factors to look at when thinking big picture:

1) Frequency: how often a certain shape is adopted

2) Magnitude: amount of force applied

3) Location: where force was applied, what structures are most affected

4) Duration: how long action was assumed

So for example, when we talk about practicing and increasing practice time to allow tissues to adapt, we're looking at these four factors, amongst others.  If someone has been practicing a half hour a day over the holidays, and then goes back to full time symphony work of 3-5 hours a day of playing, that's a huge increase in frequency, magnitude, and duration, meaning that the tissues won't have much time to adapt in a healthful, sustainable way.  If someone rarely wears high heels, and then wears them for a whole day, that's a huge increase in all of those factors as well which might result in foot, knee, hip, or back pain. 

A lifetime of sitting in the collapsed positions on the left can create undesirable structural adaptations as well.  Image from "Sad Dog, Happy Dog" by Kathleen Porter.

A lifetime of sitting in the collapsed positions on the left can create undesirable structural adaptations as well. Image from "Sad Dog, Happy Dog" by Kathleen Porter.

Many of our modern ailments are diseases of lack of movement and mechanotransduction- a lifetime of constant sitting will cause certain muscles, fascia, and bony structures to adapt in ways that we may not want, which can result in long term damage to the body.  Many of the ailments I've discussed in the last two years are simply a result of your body processing the movement input you've given it: a lifetime of head forward posture and hyper-khyphosis will change the upper spine, years spent indulging in impractical footwear affecting the knees, spine, hips, and more, and for many of us, less than ideal ways of playing our instrument can result in negative adaptations as well.  This process of converting mechanical input into cellular adaptation is precisely why moving better, gaining awareness, and self-care is so important.  By the time your body is injured, you've sent it years of poor movement patterns, so why not retrain earlier and make positive adaptations to your structure?  In regards to music, most of us practice significantly more than we move- it's just practical math.  If someone practices an instrument 2-3 hours a day (that's a conservative estimate) for 20 years, that's probably much, much more than they exercise.  If someone is a massage therapist for 4-5 hours a day for 10 years, the shapes they assume while practicing bodywork will make a greater cellular deformation.  (Also, If someone practices yoga one hour a day, every day, that still doesn't account for the quality of movement in rest of their life!  Yoga is not the only movement your body needs!)  Now none of this has to do with the current mass media model of exercise, which is work out hard+burn calories=great looking body.  This model is looking at how your body moves, not how it looks, not how thin/fat/muscular you are, but range of motion, pain, tissue health, etc.   Although weight is one factor of determining health, it is by no means the only way to evaluate.  (And for those of who are movement instructors or have a regimented training/workout process, how is your exercise affecting your tissues and what about the movement habits you adopt for the rest of the day, week, and life?)

So the question I leave you with now is how do you move?

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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."

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