Musicians' Health Collective

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

Filtering by Tag: stress

Musicians and Muscle Imbalances

Common sense will tell you that musicians (and athletes, dancers, or anyone who focuses on one human activity the majority of the time) will experience muscle imbalances at some point in their life or career.  They might not label their pain or adaptation as a result of muscle imbalances, but it's often at the root of our issues.  Let's backtrack first though.

I sort of love this picture focusing on the more aesthetic side of muscle imbalances- most imbalances won't be this obvious! I mage from Pole PT.

I sort of love this picture focusing on the more aesthetic side of muscle imbalances- most imbalances won't be this obvious! Image from Pole PT.

Muscles move bones through a combination of contraction and relaxation in tandem with opposing muscle groups (i.e. the hamstring group and the quadriceps group or opposing groups).  Contraction is also called facilitation, and relaxation as inhibition.  In the gait cycle, the hamstrings will contract to extend the hip and flex the knee, whereas the quadriceps will contract to extend the knee and flex the hip.  They work in opposition at various points in walking. (*Just to be clear, there are many other myofascial units that play a role in gait. This is just a simplified example!) Normal muscle function is when the facilitation/inhibition cycle is balanced, with no one muscle or muscle group dominating above the others.

Imbalance is when a muscle or muscle group dominates within its role in movement.  This may be due to overtraining, meaning that the opposite muscle may be weak, with limited range of motion, or have difficulty firing.  If we apply this to walking with hamstrings and quadriceps, many people over-fire their quadriceps, meaning that they don't relax after their work is done.  This may then pull on the knee cap (patella), affect the resting length of the hamstrings, and also affect movement actions like walking, extending the hip, etc.  This uneven relationship may be because of overtraining (i.e., way too much quadricep strengthening, lack of hamstring mobility or strength) or a combination of other factors.

One of the common theories to address imbalances is upper/lower crossed syndrome. This  simplified chart  demonstrates muscles that are weak, which may be inhibited, and muscles that are tight and perhaps overly dominant or overly developed. I would also suggest that the words weak vs. tight are not the best to describe the syndromes, because some muscles are weak and "long resting length" and some are weak and "short resting length." There's more to it than just weak=long and strong=short. This is still a muscle theory, which means that there are mixed feelings about whether these relationships are accurate!

One of the common theories to address imbalances is upper/lower crossed syndrome. This simplified chart demonstrates muscles that are weak, which may be inhibited, and muscles that are tight and perhaps overly dominant or overly developed. I would also suggest that the words weak vs. tight are not the best to describe the syndromes, because some muscles are weak and "long resting length" and some are weak and "short resting length." There's more to it than just weak=long and strong=short. This is still a muscle theory, which means that there are mixed feelings about whether these relationships are accurate!

Although this is still a theoretical model, many musicians do have many of these symptoms, including forward head posture, and overly kyphotic/rounded upper spine, and weakness in the back body.

Although this is still a theoretical model, many musicians do have many of these symptoms, including forward head posture, and overly kyphotic/rounded upper spine, and weakness in the back body.

What makes this issue more interesting, at least to me, is that it's not just a muscle issue.  Our nervous system plays a huge role in the way we recruit muscles and retrain them.  For example, a trauma to the tissues (accident, injury, etc) can affect the muscles long after the injury has passed.  Speaking from personal experience, I injured my knee in a bike accident 8 years ago, but my non injured hip and leg do weird compensations, even though the other leg is perfectly capable of healthy movement now.  Physical and emotional trauma can also take on an emotional/fear response- a past injury or emotionally traumatic event may evoke a sense of fear, albeit unconscious, when addressing that muscle.  Musicians who have experienced tendonitis in one arm or hand may have this sense when beginning to rehab, practicing a challenging passage, or receiving massage/bodywork.  This can also apply to more complex traumatic events like assault, physical violence, car accidents, and other events, which may force the person to dissociate from their body or areas of the body.  All of this can be labeled as a neuromuscular imbalance, which is more complex than simple "muscle weakness/strength" models.  

Putting it all together, when someone comes in with a pain symptom, either related to music or other events, it's a lot more complicated than "you're practicing too much" or "your instrument setup needs to improve."  Imbalance can be a result of 

1) Exercise/overtraining: musicians often overtrain the flexor muscles of the hands and forearms with little attention to larger muscle groups or opposing actions

2) Daily movement and lifestyle choices: This can include sitting posture, shoe choices, standing posture, sedentarism, how one holds one's case, cell phone, or belongings, and so forth.

3) Injury

4) Neurological disorders

5) Illnesses: arthritis, diabetes, chronic fatigue, and many other illnesses affect muscle tension relationships, pain, and strength.

6) Pain: Pain will affect the nervous system's ability to know where it is in space (proprioception) and will affect movement.  There have been quite a few good blogs on pain and movement, so here is one from guest writer, PT Arlyn Thobaben, to get started.

7) Stress: Stress, along with pain, can affect muscle tensional relationships.  Often when we're stressed, we move and breathe in a less than optimal way, which may enhance tension in the upper back, neck, and so forth.

How can we address these issues?  Bodywork, especially with someone who can address muscle imbalances and nervous system imbalances can be a great starting point.  General exercise can make imbalances worse if not addressed- seeking a knowledgeable trainer in pilates, corrective exercise, weight training, or other movement modalities can help restore balance to overworked muscles.  As I mentioned in the last post, everything starts with awareness, so finding a teacher in subtle body practices like Alexander Technique, Body Mapping, Feldenkrais, or other practices can be very helpful in feeling the imbalances in your own body.  Lastly, giving your nervous system the chance to relax, whether through constructive rest, massage, or meditation is a great starting point for moving out of the fight and flight sympathetic nervous system response.

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

Beta-Blockers, Performance Anxiety, and the Results of the Musicians' Health Survey with John Beder

In the last year, John Beder has not only interviewed many classical musicians about their experiences with performance anxiety and beta-blockers, but also drafted his search into a cohesive survey for ICSOM (The International Conference for Symphony Orchestra Musicians), which has not addressed musicians and performance anxiety in almost 30 years.  On Wednesday, almost a year after initially launching his Musicians' Health Survey and reviewing the data, John shared his findings at the 2016 ICSOM conference in Washington D.C.  

K: With those who were comfortable discussing their beta blocker usage, how did they impact their performances, auditions, or other circumstances?

J: Throughout the project many of the musicians we talked to about beta-blockers heard about them as the “easiest" and “quickest" way to address performance anxiety. Fast and easy of course sounds perfect when so much time is already consumed by all the other demands of the profession. While we spoke with many people who had positive things to say about the use of beta blockers, many of the musicians we spoke to about beta blockers had a nuanced view of their application. They spoke about them as complimenting a diversity of methods for addressing performance anxiety, rather than using beta blockers to get around more traditional methods of performance preparation.

Many had spent a significant amount of time studying how to perform more confidently on stage, beyond the technical and musical demands of performing. Ultimately, beta blockers are not for everyone, and are certainly not a replacement for preparation or some sort of panacea for performance anxiety. This, I think, is the most important take away from any discussion around beta-blockers: that they are a part of a larger conversation about performance skills which is missing from many of our music education programs.

K: For those who don't use them, how do they manage their performance anxiety?

J: Many of the musicians we spoke to who had not tried beta blockers also invested a significant amount of time figuring out how to address performance anxiety. Many used mindfulness techniques and meditation, while others borrowed from sports psychology with things like heart monitors, biofeedback machines, and breathing exercises. We try to talk about as many of these as possible in the film in addition to beta blockers but with the impressive quantity of approaches we only had time to focus on a few of the most practiced. It’s interesting to note as well that the conversations never started with “I don’t get nervous” since every single person we talked to expressed experiences and instances of performance anxiety. 

K: Tell me about the Musicians' Health Survey that you launched a year ago and your findings since then.

J:  It’s been a year now since we distributed the study (2015 Musicians’ Health Survey) to ICSOM and it has been wonderful to see participation from orchestras around the country. A total of 447 musicians responded and some of the results are being shared at this year’s ICSOM conference in Washington DC. Professor Williamon with the Royal College of Music in London is still working on the formal analysis but much of what we learned will be discussed and presented at this year’s conference. 

Some interesting initial data I can share about the survey is that in 1987 women made up 34% of the respondents whereas our study reported 48% women to 52% men. Today’s classical musician also reported better than average health and there was major increase in physical exercise as a method to address performance anxiety. In 1987 61% of musicians reported regular exercise and in 2015, 68% reported regular exercise. As a means for addressing performance anxiety, however, exercise was used by 17% in 1987 and 74% in 2015, a striking increase. 

With regard to beta-blockers, the study shows that 72% of ICSOM musicians have tried using beta blockers for performance anxiety. Out of that group, 90% said they would consider using them for auditions, 74% would consider them for solo or featured performances, and 36% would consider them for orchestra performances. By comparison, in 1987 a reported 27% of ICSOM musicians had tried beta-blockers, representing a significant uptick (45%) over the last 28 years. Also in 1987 of those who’d tried beta-blockers 72% said they would use them for auditions while only 4% would use them for orchestra performances compared to today’s 36%.

Some other popular methods musicians reported trying included more experience (87%), eating bananas (54%), meditation (49%), and performance psychology (44%).
 

K: How do the survey and your findings factor into your work with the documentary and your work in Musicians' performance health?

J: The 2015 Musicians’ Health Survey is really just the start of a bigger conversation we hope to have with our film Composed. We can’t encourage musicians enough to explore performance skills outside of the notes on the page. Musicians are too often left feeling isolated in their struggle with performance anxiety despite the fact that 98% of ICSOM musicians report having experienced it at some point. The statistics here and ones to follow will likely prompt conversations about the beta blockers alone but our goal is not to adjudicate on the use of beta blockers, rather to promote an environment where talking about performance anxiety is accepted and encouraged as part of what it means to be a performer.

*In Fishbein et al. (1987) Senza Sordino

K: Thanks- I look forward to hearing more about this survey and new findings as the documentary moves towards completion!

Composed will begin a US tour starting October 2016. For more information please visit composeddocumentary.com or email info@bedrocklab.com

Eustress, I stress, We All Stress- And We Adapt To It

Last Tuesday, I delved into psychological stress and mechanical stress- two very different words that actually come up in my life a lot, but mean somewhat different things.  Today, let's look at adaptation, and how we respond to stress over time.

We all know that there are good stresses that might result in great joys (getting married, buying a home, job project deadlines, collegiate projects, etc) and there are negative stresses (divorce, death, impossible deadlines, health issues, unemployment, etc.).  Hans Selye coined the term, "Eustress" to refer to constructive stress, and used the word "Distress" to refer to negative stress.  (Side note: I think Eustress would be an excellent name for a cat, much like my preferrred Renaissance composer cat names Machaut, Claudio, Josquin, and of course my favorite, Gesualdo)

With these concepts of positive and destructive stress, there are a few variants of a graph tracking peak performance and stress, in which a certain amount of stress is essential for optimal performance, but too much causes breakdown.  This makes sense as musicians, because we've experienced auditions or performances where we've played optimally with a certain amount of stress and most of us have also played poorly under extremely stressful conditions. 

Hans Selye also came up with a theory on how the body responds to stress, known as the General Adaptation Syndrome, which works in three steps (sometimes 4, depending on who is writing about it).

1. Alarm Stage: This is the body's immediate reaction to the stressor, whether it's environmental, internal, external, etc.  This would mean an activation of the nervous system and the fight or flight response, HPA axis for hormonal secretion, and the resultant changes in the body that occur as part of the fight or flight response (pupils dilate, digestion stops/slows, immune response decreased, blood pressure increases, etc.)

2. Resistance: After the initial bodily response to stress, in most cases, the stress will be eradicated and the body will return to homeostasis and activating the parasympathetic nervous system.  In other cases, the stressor will continue and the body begins to adapt to the perpetual stress.  Immune function will begin to weaken and the body will begin to have reduced energy sources for managing the stressor.

3.  Exhaustion: If stress has perpetuated, burnout will occur, putting the body at high risk for many stress related illnesses.  This is an example of chronic stress, and how the body gives outover time.  Symptoms could include high blood pressure issues, digestive issues, IBS, low energy, decreased metabolism, diminished sleep, low athletic performance, etc.  

What does this all mean?  It means that we can be aware of the stressors in our life, how they affects us, and how we respond to them.  Not all stress is negative, but chronic and perpetual stress can be detrimental to the body.  What are the stresses in your life, and how do you respond to them?

Psychological Stress Vs. Mechanical Stress: What's the Difference and Is it always bad?

I co-led a workshop this weekend on the science of stress, and my collaborator (yoga teacher/psychologist/generally awesome human) opened up with this question, which I think is apt;  "What is stress?" 

When most of us are asked to define stress, we can usually respond with the physiological manifestations of stress (digestion issues, shallow breathing, anxiety...) but we have a hard time giving a proper definition of just what exactly stress is.  Here are a few examples:

"Stress is simply a reaction to a stimulus that disturbs our physical or mental equilibrium." - Psychology Today

"The non-specific response of the body to any demand for change" - Hans Selye (Who wrote amazing books about stress, including the excellent pun "Stress without Distress" as well as "The Stress of Life")

Now things get complicated because in science, mechanical stress has a completely different definition that has been around for hundreds of years:

"In continuum mechanics, stress is a physical quantity that express the internal forces that neighboring particles of a continuous material exert on each other while strain is the measure of the deformation of the material." -Wikipedia

So to put that in normal words, Stress is the load that's applied to a structure, and Strain is the resulting deformation from the load.  Don't worry about it if that's a little opaque- I definitely needed to invest some time and research into understanding these concepts!  To put this in context, take a look at a graph from Jules Mitchell's work on stretching- take a look at her in-depth explanation of stress and strain, and how it applies to muscles.

Knowing that stress is the load applied to a structure and strain is the deformation, you can see that the elastic region is the point where soft tissue fibers will bounce back to their original length and the plastic region refers to when the soft tissue fibers are permanently altered or negatively affected by the stress (i.e. injury!).

Knowing that stress is the load applied to a structure and strain is the deformation, you can see that the elastic region is the point where soft tissue fibers will bounce back to their original length and the plastic region refers to when the soft tissue fibers are permanently altered or negatively affected by the stress (i.e. injury!).

So back to stress: there's a psychological definition and a mechanical definition, but here's the bigger question...is stress bad?  The answer is "it depends."

In terms of mental stressors, it depends on whether the stress is chronic or acute.  Are you motivated by the stress of a deadline? Or are you dealing with the chronic stress of dealing with a long term health issue?  Hans Selye, endocrinologist and stress researcher, coined the term "eustress" to refer to beneficial stress, and used the word "distress" to refer to negative stress.   We've all experienced both aspects of stress in areas of our life, as well as acute (short term stress) and chronic (perpetual). 

Back to mechanical stressors (physics/science stuff)- stress is not necessarily bad, depending on the amplitude of force and what the material can handle.  If you go back to Jules Mitchell's work, she's looking at the maximum amount of stress muscle/ligament/tendon fibers can handle via "stretching" before breakdown.  Some stretch is good- too much is destructive to the tissues.  Conversely, the body needs mechanical input (i.e. mechanical stress) to make change- running is a mechanical stress, lifting, walking, sitting...those are all mechanical stressors that affectmechanotransduction, or how our cells metabolize the movement input we give it.

This may be you on stress, or how you feel trying to read this blog on mechanical stress.

This may be you on stress, or how you feel trying to read this blog on mechanical stress.

"The stress applied to a material is the force per unit area applied to the material. The maximum stress a material can stand before it breaks is called the breaking stress or ultimate tensile stress. Tensile means the material is under tension. The forces acting on it are trying to stretch the material." -PhysicsNet.co.uk

I'll talk a bit more about the other aspects of psychological stress next time, but for now, just know that not all stress is bad and that there's a whole other world of stress in the world of physics and load science.

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