Musicians' Health Collective

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

Filtering by Tag: spine

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?

What Does Rib Thrusting Look Like?

To read more from Katy or some others to address the rib flare, visit www.nutritiousmovement.com

To read more from Katy or some others to address the rib flare, visit www.nutritiousmovement.com

This week, I've been working with my private clients about stabilizing the ribs, whether in supine movements or extensions, and it can be helpful to have some visual context.  This is a little of what  rib thrusting or rib flare looks like, and how it is an aesthetic goal in many movement disciplines, here's a short gallery of different shapes and people demonstrating (most likely accidental) rib thrust.  As mentioned in my previous blog post, it can sometimes be misconstrued as "good posture" to have the shoulders back and chest broad...but pushing the ribs forward of the midline of the body compresses the lumbar vertebrae, negatively affects the pelvic floor and diaphragm, and can really limit actually spinal mobility.  Some people will naturally have a pelvic flare, either from movement habits, activities, (gymnastics, cheerleading, ice skating, dance, etc) or just a lifetime of movement habits.  There's nothing wrong with you if you have a little of this, but starting to be aware of it will not only improve your athletic performance, but may also help reduce pain, risk of diastasis recti, or other issues that may be present.  This rib thrusting is very common in yoga-land, especially in the context of standing postures, downward dog, and back bends.

(Click through the gallery to see different images)

In some fields, like gymnastics and dance, the rib thrust may be an aesthetic goal or just be a consequence of executing a movement (i.e., do the movement at any cost to the physical body).  For those of you who have been a little perplexed about the rib thrust and what it looks like, hope this helps!  (And take a look at my previous post for more specific details on what rib thrusting is)

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.*

For the Musician Cyclists

This drawing from Carson Ellis (book is Wildwood) gives an idea of how we round our spines when we bike, especially if we have a road bike.

This drawing from Carson Ellis (book is Wildwood) gives an idea of how we round our spines when we bike, especially if we have a road bike.

Biking can be an amazing form of transportation, and just a great way to move without running or walking.  But doing anything in excess can change the soft tissue properties of the body.  Because of the rounded spine position needed, cycling and spinning compound many of the problems we see from sitting too much, including:

1. Tucked pelvis (posterior pelvic tuck)

2. Rounded upper spine

3. Head forward (check out my long blog on that issue)

That doesn't mean that you need to quit biking, but that you should incorporate some movement practices that do the opposite of this position.  I'm not necessarily advocating for yoga, since that's a whole other can of worms, but I'm advocating for a mobility practice that:

1. Brings the spine into extension

2. Loosens the tight muscles in the back of the neck

3. Explores range of motion for the hips

4. Opens the posterior muscles of the legs ( tight hamstrings and calves can exacerbate the pelvic tuck in walking, sitting, standing)

5.  Deepens a student's awareness of the body in space, and remembering how to return to neutral rather than rounded and collapsed off the bike.

This guy on the right is what I'm talking about.  Not looking great, especially with that wacky head position.  But, you can see how it's easy to bring that posture back from the bike and into the practice room, car, desk, or wherever.

This guy on the right is what I'm talking about.  Not looking great, especially with that wacky head position.  But, you can see how it's easy to bring that posture back from the bike and into the practice room, car, desk, or wherever.

Here are some other things to consider: biking can also tighten the muscles of your upper back and shoulders, and long-term, can decrease your mobility which is frustrating for musicians.  So do some shoulder work, keep working on hip mobility, roll on some balls, and pick your counter-activity carefully.  Every movement pattern we adopt affects the form and function of our body, long term, so make sure you're bringing your tissues back to neutral as you train, move, or just exercise.  

This blog is awesome for exploring biking postural positions.

Stretch out those in those shoulders here!

I like this YTU® pose for hips, and this video on the bottom for breaks in between biking, playing, driving, etc.

 

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