Musicians' Health Collective

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

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Caring for Your Feet, One Shoe at a Time

Unless you’re a full out body nerd (like myself) or a podiatrist, you probably didn’t know that April is national foot health awareness month, and since April is winding down, it's time to talk about your feet again. You may be wondering, “why is this relevant ?” or, “Geez, guess it was a slow day in health news.”  Seriously though, do you have foot, ankle, knee, hip, back, or neck pain?  Chronic, diagnosed, or undiagnosed?  What about bunions, hammertoes, collapsed arches, plantar fascitis, bone spurs, or tendonitis? And did you know that you have 26 bones in each foot, adding up to 54 foot bones out of your total two hundred and six bones in your body?  Any issue in the foot effects the whole body- high heels throw the knees, pelvis, and spine out of alignment, gait anomalies affect joint wear and tear in the ankle and knee, and a foot injury will affect gait, compensation patterns, and joint wear and tear, not to mention athletic performance and activity.  Perhaps now you’re just a little bit more interested?

A recent study at the University of Maryland concluded that 75% of people in the United States have foot pain, which I think makes this discussion relevant to the wider world.  As a culture, we are sedentary (even if you’re an athlete!) because we are sitting for 10-16 hours a day, most often in chairs.  We then place our feet in ill fitting shoes with small toe boxes, elevated heels, and non-flexible soles, and many of us attempt vigorous exercise with these constraints.   Our sedentary lifestyles, poor shoes, and minimal walking habits coupled with intense bouts of exercise mean that the muscles of our feet have checked out.  By constantly wearing shoes that restrict natural movement and toe position, we are essentially setting ourselves up for long-term issues, either in the foot or in the whole body.

Are your toes drifting towards each other?  Or is there space between your toes?

Are your toes drifting towards each other?  Or is there space between your toes?

When’s the last time you thought about self-care for your feet?  When did you last try to stretch your toes out wide?  How often do you wear elevated heels, i.e. the heel is above the toe?  (PS.  Many running shoes, cowboy boots, and men’s dress shoes have elevated heels, so this issue affects everyone!)  One of the easiest ways to address whole body health is in your shoes, and your family’s shoes.  I’ve long had right sided knee issues from a bike accident many years ago, which were always compounded by wearing heels, even "practical ones."  When I stopped wearing elevated heel shoes on a regular basis, I had a huge improvement in my pain, and increase in endurance and mobility.  So what’s the issue with wearing high heels on a regular basis?   

The smaller the toe box, the more the big toe will be smooshed towards the other toes---ouch!!!

The smaller the toe box, the more the big toe will be smooshed towards the other toes---ouch!!!

#1: They limit your toe spread ability.  Your toes have natural toe spread, believe it or not, and shoes with a small toe box limit that range.


#2: They push your big toe towards the little toes.  Whether you have a bunion or know someone who does, bunions are no fun.  Bunions are a bony lump at the MTP (metatarsolphalangeal joint), also known as hallux valgus, which results from a combination of different movement, shoe choices, and genetic factors.


#3: They put pressure on the big toe, which can encourage the body to build additional bone at the site of a present or future bunion, through a process known as Wolff’s Law.


#4: Heels force your calf muscle to contract perpetually, which may be some of the aesthetic appeal.  In addition, the foot is trapped in plantarflexion, which can affect the plantar fascia, ankles, and musculature of the foot.  However, shortened and overworked calf muscles can affect gait, standing alignment, and sitting alignment.  In addition, elevated heels affect your ability to breathe fully because your diaphragm is affecting by your postural compensation. 

Elevated heels force your body to adjust in other ways, perhaps in the spine, hips, knees, and neck!

Elevated heels force your body to adjust in other ways, perhaps in the spine, hips, knees, and neck!


#5: Heels move the pelvis and spine out of neutral alignment, either into a posterior tuck of the pelvis or anterior shift, which then will affect the spine, head, neck, and shoulders.  If you watch someone in heels walk or stand, they will most likely be rounded in the upper body as a result.

Go grab a ruler and measure your day to day shoes.  Notice if your sneakers or running shoes have a heel in relation to the front of the foot.  Now take a look at your feet-where are your toes?  Are they drifting towards each other with the big toe moving towards the little toes?  Almost all of us wear shoes regularly with some sort of elevated heel, and varying your shoes and moving towards flatter shoes with a wider toe box can help.  If you’re used to wearing heels, you soft tissues and muscles may need a transition period, as well as corrective exercises to begin naturally lengthening in response to your shoe choices.  (http://www.katysays.com/sitting-in-heels-is-the-new-smoking/)  Other suggestions: try being barefoot at home (or in socks) more often, skip flip flops (which cause our toes to grip with each step), and look for ways to strengthen the feet through Restorative Exercise, bodywork, self-massage, and physical therapy.  Whether you’re going for a walk, attending a wedding (where women wear crazy impractical shoes) or just going out on the town, consider your feet, and notice the difference.  

Last year, I did a series of foot posts, which you should check out!  Shoes make a big difference in your whole body health, as noted in Katy Bowman's two books: Whole Body Barefoot and Every Woman's Guide to Foot Pain Relief.

 




Highlights of the Last Two Months

In case you're new to the site or want to revisit some of the earlier material, here are a few highlights from the last two months of posts. 

Look at the postural change from adding heels!

Look at the postural change from adding heels!

Shoulders- From anatomy to stretches, learn about what constitutes the shoulders and how to work with restriction.

Stance and Posture-  Musicians are often told to stand in a certain way which may or may not be good alignment for their body. 

Feet and Shoes- From flip flops to heels to thick padded running shoes, we often pick shoes that don't support us while performing, walking, and standing.

Developing Awareness of the Body, by the fabulous Andrea Kleesattel.

And as always, you can search at the bottom of the site for anything you might be looking for, or click on the tags at the end of each post to see related posts.

 

 

On Shoes: Finale

As we near the end of the great foot extravaganza, here are some general suggestions for shoe and foot happiness:

1.  Don't wear heels or uncomfortable dress shoes for important standing concert situations or for long walking distances.  If you bring them with you, they'll last longer anyways.  

2.  Stop wearing flip flops as often.

3.  Don't wear heeled boots when you need to walk any sizable distance or when the weather is dubious.  (New Yorkers, are you listening? High heeled snow boots and rain boots are a death trap.)

4. Bring some self-care to those tired feet.  See post 4.

5.  When you do buy new shoes, pay more attention to the fit, the amount of space for your toes, and the heel of the shoe.

6.  Walk barefoot in your house, if you can.  This helps to restore normal muscular use for your feet, which gets undermined by shoe constriction.

7.  If you have children, make sure they wear shoes with flexible soles, especially when learning to walk.  If you're a wee little one just finding balance, why do you want to add a big bulky sole  and heel for your feet?

8.  If you're having serious foot issues, see a doctor.  Your foot alignment affects your posture, your knees, spine, head placement...the list is long.  It's worth it.

9.  If you've had a past foot/toe issue, notice if you walk differently to compensate.  Can you come back to a more even gait?  Where's the asymmetry in your feet and how does it affect the rest of your body?

10.  Even if you're not in pain now (many of you readers are spry and youthful musicians), be aware that your actions now dictate the muscular and bone structures of your future.  The soft and hard tissues of your body are constantly changing, strengthening, lengthening, softening, tightening, in response to activity, patterning, and life.  Your daily habits create long term repercussions.


On Shoes: Part 3

In part 1, and 2 I illuminated (with the help of smart biomechanists and podiatrists!) some of the issues behind high heels/shoes with small toeboxes in regards to bunions and spine.  Let's apply it to music performance and put it in context.

Scenario 1: You're a wind/brass player, and you often practice sitting.  For your quintet/solo performances, you wear heels.

Fun fact: The diaphragm is a muscle...that attaches to your lumbar vertebra.  Remember what's happening to your spine when you're wearing heels?  You're changing the shape of your spine, which affects your diaphragm. If your spinal curves are changing in response to your shoes, your diaphragm's capacity for full expansion is probably affected.  (You could also already have a hypertonic diaphragm, meaning super tight, which is also not good.)  Why would you want to intentionally shorten your capacity for a full and supported breath under pressure when you're musical instrument depends on it?  I don't know.  (Singers, I'm talking to YOU too!)  Not only that, but your body will go to the more shallow area of respiration, or that upper chest/hyperventilation breath, which is not good for anybody, regardless of instrument, under pressure.

Scenario 2: You're a string player, and you only wear heels for solo concerts.

First of all, glad you don't wear them all the time.  However, let's think about this practically.  If you practice barefooted/flat shoes on your repertoire, finding a place of neutral axial extension (good posture), neutral pelvic tilt, and good foot position (topic for another day), why are you going to throw that into limbo in a concert, when you're under pressure?  Or even worse, at an audition???  Perhaps you're not as into the whole "grounding" thing as I am, but your feet are your foundation when you're nervous, and your knees definitely shake more in heels.  (Or mine do.)  So why change another factor of anxiety and performance when you could have something absolutely consistent and secure to base your body on?  I don't know.

Scenario 3: You're a pianist, and you wear heels regularly.

I'm not a very good pianist, but I do know you need access to your pedals and your ankles/calves, in order to point and flex the feet.  (Plantar flexion and dorsiflexion).  We already know that heels limit your ankle flexibility and shorten your calves, so over time, that whole area with begin to shorten and lose range of motion.  Yikes!  That doesn't sound good.  There have been some studies on how habitual wear affects long term R.O.M., so beware!

  If you can't drive in the shoes you're wearing, you probably shouldn't walk, perform, or stand in them.

It doesn't mean that you can't wear fun shoes sometimes...it just means that you should wear them sparingly, and not in stressful performance situations.  Help your diaphragm, your feet, and your general stress level by saving the heels for a non-performance situation.

 

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On Shoes: Part 2

Now that I've got you hooked into this scintillating tale of podiatry woe, let's examine shoes and feet again, and look at some of the culprits to pain.

Heels: I know I've looked at what goes on in the spine, but let's look broader.  Much of this is from Katy Bowman's work, and her two subsequent books, which are excellent.

Doriflexion-plantarflexion.gif

1.  Heels increase plantarflexion, which increases tightness in the plantar fascia, which is unpleasant!  (plantar fascitis, anyone?) 

2.  Heels actually shorten your calves and achilles tendon, which is no good if you say, do any athletic activity on the planet.  That's how the illusion is maintained-your muscles are being adaptively shortened.  Are you a runner that wears heels by day?  Yikes!  Painful! (I started noticing this sensation about three years ago, when I would wear heels, followed by running, followed by super tight calves and psoas of steel.  Not in the good way.)

3.  The plantar flexion and downward push jams the foot down into the tiny toe box, which only exaggerates your chance for bunion and hammertoes and icky foot issues.

4.  Heels contribute to knee joint degradation and osteoarthritis.  Holy smokes, stop there!  I've mostly stopped wearing heels because of my meniscus damage from a bike accident.  I am still woefully guilty of a few elevated sandals and some dress shoes, but I'm slowly whittling my collection down, year by year.

5.  Changing the position of the spine can lead to back pain, as well as saw in post 1.  If you hyperextend your knees while standing and then flatten out your lumbar curve, it hurts!  Why would you add an instrument to that instability?

Aside from my sheer pallor, notice how toes tend to grip in flip flops as you walk...Not so great!

Aside from my sheer pallor, notice how toes tend to grip in flip flops as you walk...Not so great!

Flip flops: The classic summer time shoe...that's causing your toes to grip and your plantar fascia to tighten.  At summer festivals and in warm climates, folks like to wear flip flops outdoors and then change into dress shoes for concerts.  While flip flops are often flat (if they're not, see above!), your toes are gripping on for dear life to keep that shoe in.  That gripping is toe flexion, as well as a tightening of the plantar fascia, which can once again, lead to plantar fascitis.  Try sandals with a back strap, and with open toe boxes so your toes can spread, be free, and be happy!  (Men, this applies to you too.)  Maybe save the slippers for the beach?  Obviously, if your flip flops are flat, it's not going to affect your performance while standing or sitting unless you have plantar fascitis, which is icky and painful.  Don't forget that we change our gait pattern when we wear flip flops, often dragging our feet or just flinging our leg in front of us, rather than pressing off with the back foot.

Start looking at your shoe collection-what do you wear for long walks?  Running? Concerts?  We all have heels and flip flops and elevated running shoes, which are fine for occasional use, but not as a daily shoe.  Look at your sneakers too-is there a huge padded heel?  That may affect your spine as well.    Start wearing flats (Toms are my go-to, or these fun new Vibrams) for longer walks and notice if there's a change in your feet, your gait, and your overall body.


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