Musicians' Health Collective

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

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What is Scoliosis?

This image on the right shows a "normal" spinal curvature.

This image on the right shows a "normal" spinal curvature.

When I was a kid, we used to have these scoliosis tests in which the school nurse called you out of class, had you bend over, and then karate chop checked your spine for irregular curves.  I always remember wondering what would happen if you were found guilty of scoliosis-just being called out of class in groups was stressful enough, especially when your classmates were waiting in the same room with you.  But I digress.  

What is scoliosis?  Simply put, it's an irregular curve of the spine to the side.  We look at the human body through anatomical planes of movement (sagittal, horizontal, frontal), and the spine naturals orients its curves in the sagittal plane, but scoliosis will create curves in the frontal plane (i.e. sideways curves).  While scoliosis can correspond with certain diagnoses (sometimes called nonstructural scoliosis, correlated with cerebral palsy, muscular dystrophy), most causes are unknown, and may be a combination of genetics, injuries, habits, or other causes.  Scoliosis is defined as an abnormal spinal curvature that deviates in the sideways plane, or frontal plane.  Kyphosis and lordosis are exaggerations of the existing spinal curves (front to back- sagittal plane) either from habit (high heels, asymmetrical instruments.), genetics, aging (osteoporosis and bone degeneration) or other diagnosis.

Notice that scoliosis is a lateral curve deviation , whereas the other two examples exaggerate the native curves of the spine.

Notice that scoliosis is a lateral curve deviation , whereas the other two examples exaggerate the native curves of the spine.

So why care about scoliosis?  Well, many musicians have scoliosis but don't do much about it until the pain it causes is quite severe.  Doctors haven't agreed whether the muscles and soft tissues caused the misalignment or whether the bones pulled the muscles out of alignment, but the result can be discomfort, particularly on the side where the spine is pulled (in the images, the spine is pulled to the right side). When applied to musicians, one has to take into consideration any asymmetrical postures or movement habits, whether it's playing the violin which might exaggerate a curve to the left or playing the flute. Some musicians were diagnosed with scoliosis as a child and have adapted accordingly, whereas others have found that their body adopted a non structural scoliosis as they've aged.   (Side note: medical professionals divide scoliosis into structural, meaning the spinal curvature is difficult to reverse, and nonstructural, meaning that the spine works semi-normally, but with a curvature.  I would add that even in severe scoliosis, change is possible with medical treatment/physical therapy, because of the body's ability to adapt)  What also makes scoliosis more difficult to address is that the curve deviation is to the side, but it usually alters the curves in the sagittal plane, meaning that a lateral deviation could exaggerate a kyphosis in the upper back, or limit the natural lumbar curve.  Although scoliosis is often defined as a simple lateral deviation of the spine, the dynamic curvature of the spine makes scoliosis a more complex spinal deviation.

In the image above, the woman with scoliosis might have serious right sided pain due to the tension of the tissues on the right side, but will also have certain movement restrictions, whether in daily life or athletic endeavors.  In the old days, those with severe scoliosis got a steel rod implanted, which not only hurt immensely but also restricted all normal movement of the spine.  The steel rod is less common, though many older individuals still have it from their youth.   No one has fully "cured" scoliosis, meaning that few people return to a fully "normal" spinal curvature, but there are many ways of allaying pain, discomfort, and the effects of scoliosis.  As always, seek the insights of a medical professional if you're working with scoliosis, and make sure that any movement professional, bodyworker, or instructor understands scoliosis and how to best assist you.

1.  Therapeutic movement: work with someone who can see your patterns and help to balance out the musculature strength and weaknesses.   Going to a traditional yoga or pilates class might not help until you know your own tendencies-certain postures will be easy because they're on the good side, others less so, and to exaggerate the "good side" postures is not helpful in the long term.  Looking to balance out the sides, strengthen weak and unbalanced muscles, and decrease the discomfort is key.

here's my model skeleton with some right sided scoliosis.

here's my model skeleton with some right sided scoliosis.

2.  Ditch the high heels (and probably the spanx too).  I played a concert with an operatic soloist whose scoliosis was apparent through her gowns, and when she wore her 5 inch heels, the curve was definitely exaggerated, and probably painful.  (It was difficult to watch and wonder how that affected things.)  Remember that high heels cause spinal misalignment in the sagittal plane and can increase neck pain, low back pain, etc.

3.  Bodywork: Seeing a rolfer, a deep tissue manual therapist, and NKT practitioner...all can be really valuable.  These folks will hopefully work a bit more on the restricted side (if the spine deviates to the right, the tissues on the right may be weaker, painful and less forgiving), and help to restore a feeling of balance in the long run.

4.  Self-massage: Using therapy balls to work on your own misalignment can be empowering and pain killing, which is terrific.  Combining self massage with therapeutic movement and bodywork would be a great way to work with pain and restriction.

5.  Take a moment to look at how you sleep, especially if you're a side sleeper.  There has been some involved research about long term changes from sleep patterns, and if you always sleep on the good side (or bad side), you might be increasing your pain and discomfort unknowingly.

6. Know your curve.  Figure out where in the spine your deviation is, what movements hurt (or don't hurt), where you have pain, and what you need to work on.  Taking agency for your own body aids other practitioners in helping you more effectively.

*Oh, and quick point, if you teach very young children, watch to see how they stand and sit.  Try to gently guide them to upright positions so as to avoid spinal misalignments down the line.  Scoliosis is technically idiopathic (don't know the cause), but when instruments like violin/viola and brass instruments favor one side and children start early, there's a possibility of long term adaptation, especially given how malleable bones and soft tissues are in our youth.*

Self- Care in Uncertain Times

In the last few weeks I have not been sleeping well, writing, or doing much of note.  Between the political unrest, violence, and the strikes of various American orchestras, I haven't been feeling terribly chipper or useful to society.  With so much conflict and chaos currently going on, it's hard to know how to help, especially as an orchestral musician and movement teacher.  

Beauty can be seen in all things, seeing and composing the beauty is what separates the snapshot from the photograph..jpg

Last week, biomechanist Katy Bowman released a great podcast episode about the importance of movement in uncertain times.  I agree with all of the points made in that episode, but even more so that in challenging times, we must take care of ourselves.  As a movement teacher, I try to help people move better and become more embodied, something that I have to remember to do for myself.  When athletes are training, the notion "work+rest=success" is paramount. In our daily lives, most of us do plenty of work, but are we resting or creating conditions for down-regulation?  The body needs the chance to down regulate daily, whether it be through a movement class, meditation, constructive rest, walk, or massage.  We are better able to be receptive when we are not full to the brim, and our actions will be more intentional and meaningful.  From there, we can begin to take action- whether it is volunteering in the community, calling legislative leadership, teaching, performing at a community venue, picking up trash, or more, we must start from a candle that's not burning at two ends.  If you're wondering how to start, I like to open the question, "how can I be of service?" and that usually leads me to a good place.  Wishing everyone a good holiday season

kayleigh

Sleeping Better

Last week, I talked a little about how important sleep is, and what can go wrong if we don't get enough sleep.  Some of the primary reasons we don't get enough sleep are interruptions- which could include snoring (90 million Americans snore), sleep apnea (18 million have sleep apnea), restless leg syndrome, nocturia, circadian rhythm disorders, and of course, stress and anxiety.  While I am no expert on apnea or snoring, I have dealt with stress and disordered sleeping for most of the last decade, sometimes with success, and sometimes not. 

When the body is in a state of hyperarousal, the fight or flight aspect of our nervous system kicks in, and our body is flooded with cortisol, adrenaline, and often, lots of thoughts flurrying about.  Couple that with a caffeine addiction (which has a half life of 5-6 hours) and the use of computers in beds, and no wonder we can't sleep! 

Most of us have heard that the blue light wavelength found in phones, tablets, and computers can distort our natural sense of time.  Harvard Researchers and the National Sleep Foundation have been doing research on the effects of our using technology before sleep, and the results aren't great.  2/3 of the people surveyed watch TV in the hour before bed, and 1/2 were on tablets, computers, or phones.   The blue light in LED's can prevent melatonin from running its course and promoting health sleep times. 

We don't know the long term effects of radiation, wifi, and other technological signals on the brain and sleep.  Consider airplane mode, turning things off, and keeping them away from bed!

We don't know the long term effects of radiation, wifi, and other technological signals on the brain and sleep.  Consider airplane mode, turning things off, and keeping them away from bed!

So what can you do?

Don't exercise in the hour or so before sleep.  I remember seeing people at the gym at 10 and 11 at night while I was in college-not great for sleep and relaxation right afterwards.

Check your afternoon caffeine habit and stop drinking coffee or strong tea after mid afternoon.  I like to stop by 2, but that's just me. 

Don't put your phone by your bed.  Not only does the blue light affect sleep, there is also question as to whether the radiation from phones affects sleep and all over health.  I try to put my phone on airplane mode, which I swear makes a difference at night! 

Ah, the good ol' days of storytime.

Ah, the good ol' days of storytime.

If you always watch tv on your computer or tablet, think about stopping a little earlier and reading an actual book or magazine.  I'm a sucker for moderately depressing netflix documentaries, and many of my books are on my ipad, so it's a good challenge to read an actual paper object when I want to sleep.  I try to either turn off all of my devices or put them on airplane mode if they're near my bed or acting as my alarm, and I'm convinced I sleep better when I do that.  It also guarantees that I won't be interrupted by a weather alert, text message, or other sound alert.

De-stress.  Carrying your stress around with you at night is a recipe for disaster.  I personally meditate before bed, and that helps, but that's not for everyone.  I love body-scans, which are found in many meditation and somatic practices.  Some people love a warm bath before bed, which can yield similar benefits.  If you have a long to-do list for tomorrow, consider writing everything down that needs to be done, allowing the brain to let everything go and focus on the task at hand.  If you watch tv or movies before bed, consider watching things that don't stress you out- I usually avoid violent action movies anyways, but things that put the body in a stress reaction won't help either.

One of the challenges that I've had to work with is finding a balanced sleep schedule when I have auditions or concerts coming up, and many of these suggestions have helped immensely.  Creating a dark space for sleep also helps, as well as wearing earplugs or having a quiet environment.  Consistent bed times are also great for establishing routine, as well as consistent waking times.  As I mentioned last week, sleep is necessary, so we might as well make the most of it!


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Neck Gnarl, Sleeping, and Other Stories

Just to complete some of my thoughts about neck issues and what you can do with the neck congestion, here are a few videos from Dr. Katy Bowman (biomechanics awesomeness) and Kelly Starrett, a PT, cross fit man, and maker of hilarious videos.

This first one is a roll-out plus anatomy drive-by with Kelly Starrett and Jill Miller, and it's a doozy.

This quick video is a promotional byte for Katy's program, but it also illustrates the issues of forward head position, just in case you missed it last week, or are still confused.

Just in case you're a little fuzzy on all the anatomy talk here, here's a quick view!

Just in case you're a little fuzzy on all the anatomy talk here, here's a quick view!

How are you sleeping?  To keep your neck happy as you sleep, don't sleep on your belly!  While there is no universally agreed upon pillow position for sleeping (Dr Bowman says no pillow!), the first half of this video gives great insight into some sleeping problems that might be going on for you sometimes.

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