Musicians' Health Collective

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

Filtering by Tag: standing

Suzuki Turn-Out No More

Who decided that we should all stand with one foot forward and externally rotated?.jpg

     I started my humble music career as a Suzuki violinist, beginning at the age of 6.  While there are many useful and important things I learned in my early training, standing position was one that has posed confusion as I've aged.  Let me explain a bit more, for those non-violinist or violists out there.

This is a perfect example of learning "proper" violin stance.  Start with the feet together, then turn the feet out (externally rotating hopefully from the hip, hopefully) and then step the left foot forward.

This is a perfect example of learning "proper" violin stance.  Start with the feet together, then turn the feet out (externally rotating hopefully from the hip, hopefully) and then step the left foot forward.

When one learns beginning violin, often one is told to turn the feet out and step the left foot forward.  I learned this way, and stood this way for a long time.  (Over 15 years, at least).  A few years ago, I started noticing that in yoga, pilates, and weight training, we were told to have both feet pointing forward, at least sometimes.  I instead wondered, why do I always turn my feet out when I play, and does it actually serve me?  I have since started experimenting with this concept. 

This adorable image is from Shirley Givens' violin series, showing that left foot turnout.  In addition, the illustrated girl puts much more weight on her left foot, enhancing the asymmetry of the stance.

This adorable image is from Shirley Givens' violin series, showing that left foot turnout.  In addition, the illustrated girl puts much more weight on her left foot, enhancing the asymmetry of the stance.

So what's the big deal?  Our feet naturally point forward or with a minimal turnout, and you may already remember that when you walk with your feet extremely turned out, there are potential consequences for foot, knee, and hip issues.  (In addition, when feet point forward rather than externally rotated, the musculature of the foot is better able to support the body in standing and walking, and the ankle joint is able to articulate more fully.)  From a biomechanical perspective, I don't understand why music educators have been teaching students to externally rotate their hips while standing, and I definitely don't understand why one foot needs to be in front of the other.  I just don't.  (Who decided this was a good idea?)  However, I don't only care about the feet, but I care also about what is happening in the hips too.  When one hip is perpetually externally rotated (left hip), we can exaggerate that asymmetry out of the practice room, and in our daily walking, standing, and movement lives, even if we don't intend to.  That means that one set of external hip rotators is constantly working more than the other set, which can affect the muscles, bones, and connective tissue over time.  What does that mean? 

See how the right side is higher than the left?  Mine is the opposite-my left side is shorter than my right.  Pelvic tilt Image from http://medical-dictionary.thefreedictionary.com/

See how the right side is higher than the left?  Mine is the opposite-my left side is shorter than my right.  Pelvic tilt Image from http://medical-dictionary.thefreedictionary.com/

Side note, I came to this conclusion because of certain issues I was having in my hip, and that I was seeing in other colleagues of mine.  Here are some of my personal symptoms, which may or may not be yours:

1. My left hip has consistently turned out more than my right, whether I'm in music mode, standing, cooking, walking, running, etc. This can simply manifest as the foot turning out, at least in appearance. Both hips want to turn out in standing though.  I've been working on gently bringing the legs back to neutral, and found that to be helpful.

2.  This in turn can cause my left external rotators of the hip and the low back muscles to be unruly.  (Muscles include my gluteus medius, TFL, Quadratus lumborum, and the iliotibial band of fascia.

3.  I also have the beginnings of a baby bunion on my left foot which may be impacted by the external rotation of the hip.

4.  From a combination of asymmetrical music-making, left side dominance, and a host of other things, my entire left side is loads tighter (less range of motion from sole of the foot up to the shoulder!) than my right, which means that I sometimes have back pain and other issues on just the left side.  

So what's the solution?  Start to get curious. It's also important to remember that correlation does not imply causation- my left hip/back issues aren't inherently caused by the turn out, but I would venture to say that the perpetual external rotation has impacted things.  I will say that my pain has diminished exponentially since I've been doing pilates and other movement activities that have challenged my hip range of motion and stability.   

Ask yourself:

-How do you stand when you're playing? Where are your feet, knees, and pelvis?  What sort of shoes do you normally wear?  How might those be affecting your lower body?

-How do you teach your students to stand?  If you have a specific way of teaching stance, why do you teach what you do? 

-Try standing differently.  Maybe feet closer together, more parallel, right leg in front, both legs in the same orientation...give yourself permission to experiment, and perhaps that will change how you teach.

-Do you sit when you practice at home, and if so, what are your legs doing?

-If you photograph yourself (or video) while playing, what does your standing look like in context?

-Do your feet turn out when you walk/run/play/sit/etc?  Start experimenting with changing that setup gradually and see if it changes how you feel.  It can have ramifications all around the lower body, specifically feet/knees/hips/spine, but maybe affects other aspects as well.

Playing an instrument requires movement within the body- it's not meant to be a static endeavor, but repeating the same position in perpetuity for twenty plus years may not be the best.  

 

Your Spine and Hips are Suffering from Your High Heel Use

I'm getting ready for my healthy feet workshop next Saturday, and came upon yet ANOTHER idiotic article on how high heels are "healthy."  Here's one of my favorite quotes:

“You shouldn’t walk in heels higher than three inches,” she says. “Anything over the three-inch mark changes the biomechanics of how you walk—your strides are shortened, you can’t walk as fast, your body weight shifts to the ball of the foot, which throws off your center of gravity and stresses the knees and lower back.”

Um, hello?  All high heels do that.  Not just ones over three inches- all elevated heels affect your gait pattern and standing, so here's a video I made last year showing how standing is affected by heels.  Do you believe me yet?  Also, this crazy article in the NY times reminds us that there are people wedded to their heels in crazy ways!

Just as I did in the video, can you see how I can arch my upper back (AKA. thrust my ribs forward) more to stand up "straight"?  Or I can bend my knees and create hyperkyphosis in the spine in A, or B, hyperextend/straighten the knees and overarch the lumbar and thoracic curves.  In addition, you can hyperextend your knees and look more like letter B.  There are quite of few combinations of these postural tendency.  What do you think the effect of these shapes are on your body? Every time you wear any sort of heel, even a low heel, you are affecting the geometry of your joints, your natural gait pattern, your ankles, knees, hips, spine, and pelvic floor muscles! 

Just as I did in the video, can you see how I can arch my upper back (AKA. thrust my ribs forward) more to stand up "straight"?  Or I can bend my knees and create hyperkyphosis in the spine in A, or B, hyperextend/straighten the knees and overarch the lumbar and thoracic curves.  In addition, you can hyperextend your knees and look more like letter B.  There are quite of few combinations of these postural tendency.  What do you think the effect of these shapes are on your body? Every time you wear any sort of heel, even a low heel, you are affecting the geometry of your joints, your natural gait pattern, your ankles, knees, hips, spine, and pelvic floor muscles! 

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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