Musicians' Health Collective

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

Filtering by Tag: sitting

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!

Confession: I love my Standing Desk

I have a standing desk in my apartment and I love it.  While you may think that musicians don't spend much time at a computer, you'd be surprised how much time can be spent writing emails, writing blogs, wasting time, and so forth.  So last year, when I moved, I decided to ditch my traditional desk and go rogue.  No chairs, no stools, just a high table from Ikea with my desk top computer on top of it.  Although I wasn't sure what I'd think initially, after a year, my consensus is that it can be great and here's why.

Complete with two half domes for stretching my calves, I love my standing desk.

Complete with two half domes for stretching my calves, I love my standing desk.

Since I primarily play in orchestra as my career, I have a certain number of forced hours of sitting, say 3-6 hours most days.  I also drive my car from time to time, so let's factor that into things as well.  I've also sat for 8-12 hours for most of the last 15 years, especially when I had lots of studying and homework in high school.  That's a lot of sitting and habits to undo, and I don't even work at a computer most of the time.  Cumulatively, I have restriction in my hamstrings, calves, hips, and low back as a result.  Standing requires that my hamstrings be in a lengthened position for as long as I'm upright, and I've noticed more range and strength gains in the last year.  While I stand, I also stretch my calves and feet, roll out my feet with YTU balls, and play on a wobble board.  I'm more likely to leave the computer and take a break rather than just stand static the whole time.  I also use the computer less, since standing takes more energy.  I'm less likely to get sucked into staring at my computer for hours on end because I'm not lying down on a couch or bed.  I'm also more aware of how I stand as opposed to sitting, since the couch slouch is so easy to adopt.

Read it!

Read it!

Here's the thing though- I'm only using my computer a few hours a day.  I don't have a computer based job, and I'm not at a workstation all day long.  My body adapted pretty quickly to a few hours of daily standing, but if I had to do it 6 hours a day, I would need a break.  That's why many people advocate for a "dynamic workstation," which is just a fancy way of saying that it's adjustable.  You can stand, sit on a stool, lean, and so forth.  The problem with sitting at a desk is that you're assuming a static position for hours on end, so standing for hours on end isn't the solution either.  We need to change position more often, not assume the same position all of the time, and integrate more movement into our day.  Walks!  Squatting!  Hanging!  It's all good.  So whether that means putting your laptop on the kitchen counter sometimes or sitting on the floor, give it a shot.  Diversify your movement diet, especially when using the computer, and notice how much you sit in a chair.  And obviously, read Katy Bowman's book, "Don't Just Sit There" and learn about how your work environment is affecting your body.

Here are some more articles and light research though, for the more scientifically inclined.  Some studies have shown improvements in mood and energy, some have shown improvements in productivity, and some have shown no improvements whatsoever.  Many of these articles and people miss the big point, which is that humans need to be moving more.  A standing desk can create more movement opportunities for people, and changes the geometry of the body (perpetual sitting) in a good way.

Everything Science Knows About Standing Desks: With all research, take a critical eye to the conclusions.  Are the individuals being asked about day to day pain from sitting?  How about mobility or strength?  Did they transition to standing or try to go cold turkey? 

Standing Up at Your Desk May Energize You, But... Notice that this woman starts by wearing high heels at her stand up desk which pretty much eliminates all of the benefits of standing right away.  In addition, just deciding to stand 6-8 hours a day instead of sit isn't necessarily beneficial either-your body isn't primed to be static for that long in standing, especially without gradual transition. 

Why I Killed My Standing Desk Similar to the lady in the second article, this person moved immediately into standing desks and noticed that he was tired and in pain from standing.  His body had adapted to sitting, so he eventually went back to sitting. 

"Don't Just Sit There"-How Much Are you Sitting Every Day?

"Dynamic" and "standing" workstations are popular these days, both at home and in the office workplace.  The NY Times even had a mildly ridiculous article on "what to wear at a standing work station."  Although I could care less what you wear at your desk, musicians tend to think that such trends in movement and computer use don't apply to them, and I'm here to refute that.  (Side note: my teacher in restorative exercise, Katy Bowman, just wrote an excellent book called "Don't Just Sit there" from which this opening quote is taken.  It's a good book.  Go get it!)

Musicians sit a lot, whether it's in rehearsal where you have to sit 3-6 hours a day, or in your car, or at home, or making reeds, or because you play an instrument that requires sitting like piano or cello.  Some people are logging 12-16 hours of sitting a day!  The position of sitting in a chair has its own consequences- restricting mobility in the tissues and joints, alteration of the resting length of muscles, and for some people, more substantial postural issues can emerge, such as forward head position and pelvic floor issues from poor alignment!  Then factor in that HIIT (High Intensity Interval Training) is all the range in the exercise community- think extreme bouts of intense athletic training, and no wonder people are in pain.  If you imagine that you're sedentary and chair bound for 8-10 hours a day, and then try to pursue intense athletic feats with little transition, that's a recipe for pain, tissue damage, and potential injury.  Last year, I talked a bit about how to sit less and move more, and some of consequences of long term sitting, but there's also a correlation with diseases including repetitive stress injuries, cardiovascular disease, cancer, diabetes, and premature death. 

So how does this apply to you?  Do you always practice sitting down?  (If you play an instrument that requires sitting, the answer is probably yes).  How many hours a day are you sitting to practice or rehearse?  How many hours a day are you sitting for other activities, such as eating, teaching, driving, or using the computer?  If you don't have to practice sitting, try standing for part of your practice session, or sitting in a different chair.  When teaching, I often like to stand so that I can see what the student is doing from different angles, rather than be stationery and observe.  Start to become more aware about how much you're sitting, and when you need to be sitting (rehearsal), and when you perhaps don't need to be sitting so much.  Next time, I'll share a bit about my standing computer workstation (yes, I have one of those), and how it's helped me.

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