Musicians' Health Collective

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

Filtering by Tag: muscles

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.

A Quick Dose of Back Side Anatomy

Most folks have a vague idea of what's going on in their backs, but let's clarify.  In your vertebral column, you have 24 vertebrae: 7 cervical (neck), 12 thoracic (thorax-ribs area), and 5 lumbar.  The cervical vertebrae are the most mobile, giving you the ability to turn your neck in many positions.  The thoracic ribs articulate with your 12 sets of ribs to protect the viscera, assist in breathing, etc.  The lumbar vertebrae are larger, less mobile, and support the weight of the torso.

When viewed from the side, the spine has a series of natural lordatic and kyphotic curves.  Poor alignment often distorts these curves into a single C curve.

When viewed from the side, the spine has a series of natural lordatic and kyphotic curves.  Poor alignment often distorts these curves into a single C curve.

In between each vertebra is a cartilaginous "invertebral disc," which I mentioned last week in relation to osteoporosis.  These discs act as shock absorbers while also helping to maintain the structure of the spine.  Misaligned discs can be painful, or not.  Many people have slightly herniated discs (meaning displaced) and have no pain or symptoms from it while others have serious issues, including compressed nerves and persistent pain.

Image from Grey's Anatomy of Erector Spinae and intermediate spinal muscles.

Image from Grey's Anatomy of Erector Spinae and intermediate spinal muscles.

Muscularly speaking, there are many layers of muscle stacked on top of each to make up this portion of your posterior kinetic chain (a fancy way of side your backside).   Our deepest level of posterior muscles are a series of very small muscles running between individual vertebrae, specifically the transversospinalis muscles.  They assist with maintaining healthy curvature of the back, as well as bring the spine into extension, or what we think of as a backbend.  The intermediate musculature is what you see here on the right-this series of long cord-like structures, which assist in extension as well as side bending in the spine. 

Superficial musculature is often more of what you can see on someone's back side-muscles like the trapezius, latissimus dorsi, etc., both of which play a major role in moving the shoulders and neck, as well as spine.  (Lats are a big player in pull ups, and the trapezius often gets very tight and restricted in musicians).

A detailed look at the muscles of the back and shoulders, courtesy of Encyclopedia Brittanica.  The left view is the topical view, sans epidermis, and the view on the right peels one layer of back myofascia off to look deeper. 

A detailed look at the muscles of the back and shoulders, courtesy of Encyclopedia Brittanica.  The left view is the topical view, sans epidermis, and the view on the right peels one layer of back myofascia off to look deeper. 

I found this image on the internet, but I have no idea where it came from.  I do love it, though!

I found this image on the internet, but I have no idea where it came from.  I do love it, though!

Your spine moves ultimately in 6 directions- round, extend (hello cat/cow), side bend both sides, and twist both sides.  The musculature of your back (as well as the muscles of your front) help support the spine and organs as you make these movements, which help keep the invertebral discs healthy, and lengthen compressed areas in the body.  The muscles of your pelvis and abdomen are also incredibly important to postural maintenance and stability, but we'll talk about those another day.

Can you see how if a musician is short in one side of their body, due to an asymmetrical instrument, they might have misalignment and back pain?

Musicians and Muscle Imbalances

Common sense will tell you that musicians (and athletes, dancers, or anyone who focuses on one human activity the majority of the time) will experience muscle imbalances at some point in their life or career.  They might not label their pain or adaptation as a result of muscle imbalances, but it's often at the root of our issues.  Let's backtrack first though.

I sort of love this picture focusing on the more aesthetic side of muscle imbalances- most imbalances won't be this obvious! I mage from Pole PT.

I sort of love this picture focusing on the more aesthetic side of muscle imbalances- most imbalances won't be this obvious! Image from Pole PT.

Muscles move bones through a combination of contraction and relaxation in tandem with opposing muscle groups (i.e. the hamstring group and the quadriceps group or opposing groups).  Contraction is also called facilitation, and relaxation as inhibition.  In the gait cycle, the hamstrings will contract to extend the hip and flex the knee, whereas the quadriceps will contract to extend the knee and flex the hip.  They work in opposition at various points in walking. (*Just to be clear, there are many other myofascial units that play a role in gait. This is just a simplified example!) Normal muscle function is when the facilitation/inhibition cycle is balanced, with no one muscle or muscle group dominating above the others.

Imbalance is when a muscle or muscle group dominates within its role in movement.  This may be due to overtraining, meaning that the opposite muscle may be weak, with limited range of motion, or have difficulty firing.  If we apply this to walking with hamstrings and quadriceps, many people over-fire their quadriceps, meaning that they don't relax after their work is done.  This may then pull on the knee cap (patella), affect the resting length of the hamstrings, and also affect movement actions like walking, extending the hip, etc.  This uneven relationship may be because of overtraining (i.e., way too much quadricep strengthening, lack of hamstring mobility or strength) or a combination of other factors.

One of the common theories to address imbalances is upper/lower crossed syndrome. This  simplified chart  demonstrates muscles that are weak, which may be inhibited, and muscles that are tight and perhaps overly dominant or overly developed. I would also suggest that the words weak vs. tight are not the best to describe the syndromes, because some muscles are weak and "long resting length" and some are weak and "short resting length." There's more to it than just weak=long and strong=short. This is still a muscle theory, which means that there are mixed feelings about whether these relationships are accurate!

One of the common theories to address imbalances is upper/lower crossed syndrome. This simplified chart demonstrates muscles that are weak, which may be inhibited, and muscles that are tight and perhaps overly dominant or overly developed. I would also suggest that the words weak vs. tight are not the best to describe the syndromes, because some muscles are weak and "long resting length" and some are weak and "short resting length." There's more to it than just weak=long and strong=short. This is still a muscle theory, which means that there are mixed feelings about whether these relationships are accurate!

Although this is still a theoretical model, many musicians do have many of these symptoms, including forward head posture, and overly kyphotic/rounded upper spine, and weakness in the back body.

Although this is still a theoretical model, many musicians do have many of these symptoms, including forward head posture, and overly kyphotic/rounded upper spine, and weakness in the back body.

What makes this issue more interesting, at least to me, is that it's not just a muscle issue.  Our nervous system plays a huge role in the way we recruit muscles and retrain them.  For example, a trauma to the tissues (accident, injury, etc) can affect the muscles long after the injury has passed.  Speaking from personal experience, I injured my knee in a bike accident 8 years ago, but my non injured hip and leg do weird compensations, even though the other leg is perfectly capable of healthy movement now.  Physical and emotional trauma can also take on an emotional/fear response- a past injury or emotionally traumatic event may evoke a sense of fear, albeit unconscious, when addressing that muscle.  Musicians who have experienced tendonitis in one arm or hand may have this sense when beginning to rehab, practicing a challenging passage, or receiving massage/bodywork.  This can also apply to more complex traumatic events like assault, physical violence, car accidents, and other events, which may force the person to dissociate from their body or areas of the body.  All of this can be labeled as a neuromuscular imbalance, which is more complex than simple "muscle weakness/strength" models.  

Putting it all together, when someone comes in with a pain symptom, either related to music or other events, it's a lot more complicated than "you're practicing too much" or "your instrument setup needs to improve."  Imbalance can be a result of 

1) Exercise/overtraining: musicians often overtrain the flexor muscles of the hands and forearms with little attention to larger muscle groups or opposing actions

2) Daily movement and lifestyle choices: This can include sitting posture, shoe choices, standing posture, sedentarism, how one holds one's case, cell phone, or belongings, and so forth.

3) Injury

4) Neurological disorders

5) Illnesses: arthritis, diabetes, chronic fatigue, and many other illnesses affect muscle tension relationships, pain, and strength.

6) Pain: Pain will affect the nervous system's ability to know where it is in space (proprioception) and will affect movement.  There have been quite a few good blogs on pain and movement, so here is one from guest writer, PT Arlyn Thobaben, to get started.

7) Stress: Stress, along with pain, can affect muscle tensional relationships.  Often when we're stressed, we move and breathe in a less than optimal way, which may enhance tension in the upper back, neck, and so forth.

How can we address these issues?  Bodywork, especially with someone who can address muscle imbalances and nervous system imbalances can be a great starting point.  General exercise can make imbalances worse if not addressed- seeking a knowledgeable trainer in pilates, corrective exercise, weight training, or other movement modalities can help restore balance to overworked muscles.  As I mentioned in the last post, everything starts with awareness, so finding a teacher in subtle body practices like Alexander Technique, Body Mapping, Feldenkrais, or other practices can be very helpful in feeling the imbalances in your own body.  Lastly, giving your nervous system the chance to relax, whether through constructive rest, massage, or meditation is a great starting point for moving out of the fight and flight sympathetic nervous system response.

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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