Musicians' Health Collective

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

Filtering by Tag: stretches

Detangling the Pecs: Part 3

Image from  Erik Dalton

Image from Erik Dalton

This week, we've looked a little at what the pectoral muscles do, specifically the pec minor, and how restriction with the front of the chest muscles can bring the shoulders protracted and internally rotated.  Now, how can we start to create change within those muscle groups to better balance out the shoulder joint?

1) Address the restriction on the front via awareness: is it a result of your instrument? Your sitting habits? Your driving habits? Do you notice your shoulders slumping forwards in daily activities?

2) Correction with outside feedback: It can be tempting to just think "I need to bring my shoulders back and down," but that's not helpful either.  The shoulder joint is highly mobile, and even though restriction in the front may be an issue, there may be other culprits that could use attention, whether it's in the neck, the spine, or the shoulders themselves. In addition, a shoulder blade moving forward, or protracting, may also be internally rotating. (see video below)  I'd recommend seeing some sort of movement professional (PT, massage therapist, pilates teacher, trainer, body mapper, Alexander Technique teacher, etc.) and ask for some feedback.  (As always, if you're in a place of acute pain, see a doctor for a full assessment!) Although I primarily teach pilates and Yoga Tune Up®, there are many well educated movement professionals in different fields that can help you identify your issues.  One thing I find helpful is to take pictures on a phone of your shoulders/collarbones, and just use those as a reference as you start to make changes.

The infraspinatus and trees minor are key muscles to look at strengthening.

The infraspinatus and trees minor are key muscles to look at strengthening.

3) Mobilize and Work to strengthen your external rotators of your shoulder: So for every muscle group that contracts, there is an opposing muscle group that's relaxing.  The muscles on the back of the shoulder blade are primary external rotators of the shoulder, and can help bring the arm bone back and done, but without forcing it in an inorganic way.  How does one strengthen these muscles? Most movement disciplines have some form of strengthening built in of these muscle groups, but here are some of my favorites:

This may seem really easy, but if the spine and ribs are stable, and the arm bone not moving forwards or backwards, it can be a real challenge.

This may seem really easy, but if the spine and ribs are stable, and the arm bone not moving forwards or backwards, it can be a real challenge.

1) This classic strengthening exercise involves either a theraband or a set of small hand weights (like the dinky vinyl coated ones).  One can do it standing or side lying, but essentially, the goal is to keep the upper arm bones, or humerii, stable as you pulse the hands away from the body.  This video shows how to do the same exercise in standing, with a theraband.  One can also do it in standing without any resistance.

2) Reassess your plank poses, downward dogs, or even quadruped/ hands knee poses.  Many times I see students in internal rotation from the onset of class, and learning how to externally rotate the arms in weight bearing positions in critical, especially if you practice weight bearing positions.  One of my favorite Jill Miller videos is about the challenges of downward dog for the shoulder.  If you're a yoga student, this video is a must!  Here are a few other blogs about the challenges of Downward Facing Dog.

3) Look at where you may be missing range of motion in your shoulders: I love shoulder flossing, either with a theraband, Fletcher Pilates towel, yoga strap, or other device.  This great video by Christine Jablonski shows one of my favorite Yoga Tune Up® exercises.  Although this isn't a particular strengthening exercise, it can help bring awareness to where you need mobility in the shoulder.

4) Bring some length to the front of the chest via floor angels.  This is one of my favorite exercises, and it can be down with the upper half of the body on a foam roller or bolster or block.  The number one objective is to keep the ribs down (which the woman on the right is NOT doing) to really assess where your actual range of motion is. Once the spine starts moving, you've lost the intention of the exercise.  This is a classical Katy Bowman exercise, but this video  also describes it well.

Although there are many ways to strengthen the shoulder and start to bring change into the shoulder joint, here are a just a few ways to get started~

Why Bother Stretching?

A few months ago, I opened a big ol' can of worms with the discussion of how stretching doesn't actually lengthen muscles.  Now, it's time to address that subject again, with the help of Stretch Armstrong, which some of you may remember from your youth. 

If you're a child of the 70's or 80's, you may remember this toy, clad in a speedo or a tee-shirt, depending on the decade that you lived in. 

If you're a child of the 70's or 80's, you may remember this toy, clad in a speedo or a tee-shirt, depending on the decade that you lived in. 

In case you missed our previous chat, take a moment to catch up on the last post in case things are a bit confusing.  Basically, in many movement disciplines, teachers and professionals perpetuate the idea that we must stretch muscles to lengthen them.  Period.  I went to a few yoga classes this weekend, both of which said this.  "We just lengthened your hamstrings a bit so you should feel open."  Being the slight know it all that I am, it's time to correct that notion and learn a little more about the science of stretch.

This pose, a pigeon variation, is often a "dream goal" pose for yoga folks.  Does this degree of spinal flexibility necessarily serve us all?  Perhaps not.

This pose, a pigeon variation, is often a "dream goal" pose for yoga folks.  Does this degree of spinal flexibility necessarily serve us all?  Perhaps not.

Back to Stretch Armstrong-there's an idea in yoga and in other movement disciplines that the infinite stretchability is the goal, AKA.  stretchier=better=magical poses and feats.  Yet, like Stretch Armstrong, when we stretch things, our body (hopefully!) goes back to the initial tissue length...depending on how intensely we stretched our tissues.

-Our connective tissues have about 4% healthy stretching range, meaning that your tissues can "stretch" about 4% healthily.  Collagen starts to break down at 8% of your stretching range, which means that you are in a damaging range, risky for muscle tears, etc.  (Thanks Jules Mitchell for the stats!) This means that YOU ARE NOT STRETCH ARMSTRONG, ladies and gentleman, nor should you strive for such a feat.  There is a healthy end range of stretch for all of us, and it doesn't need to be pushed beyond reason.  (Also, 4% is not very much, in case you were wondering, which is why I stick to the logic that muscles are not being lengthened much with stretching.)

- Our flexibility is heavily governed by our tolerance, which means that our nervous system prevents us from going into ranges that we don't frequently use (like the splits!), because it's unfamiliar and potentially risky.  Over the course of a yoga class, for example, your tolerance will change because your nervous system is allowing range, the muscle isn't actually lengthening.  (Remember how you might be flexible in a hot yoga class and then the next day, it's like it never happened?  Your hamstrings are the same as ever?  That's because of a phenomena called Creep and Recovery (which is how the body recovers from stretching back to its normal resting position).  Stretch Armstrong does not have this capacity, nor does he have a nervous system (unless he's some hybrid of Chucky and that's just eerie).

I took this picture at a zoo last year- I loved the one sedentary zebra juxtaposed with the crazy rolling zebra.  We tend to be a teensy bit sedentary which affects our range of motion and flexibility-lets move more, folks!

I took this picture at a zoo last year- I loved the one sedentary zebra juxtaposed with the crazy rolling zebra.  We tend to be a teensy bit sedentary which affects our range of motion and flexibility-lets move more, folks!

What is flexiblity?  Basically, flexibility is having a normal range of motion in your whole body.  Therefore, if you DO NOT have normal range of motion, stretching can help work that range and then it's time to strengthen.  Remember that stretching for stretching's sake will not help much, but a combination of stretching and strengthening will help create sustainable change.  Moving frequently in more ranges of motion will help most (read more here!).  Time out: I've done yoga for 7-8 years and stretched my hamstrings for a long time, with little change.  What helped is actually getting a standing desk, wearing flat shoes, and walking more.   Fascinating- I needed to gain strength in more ranges.  Lunges, standing yoga poses, walking, squats- these are all strengthening poses and movements. 

  Whatever range you're trying to change (hamstrings, shoulders,etc.) also requires strength at that range- you don't want to stretch without supported strength.  So while Stretch Armstrong's stretchability implies that muscles are infinitely lengthen-able, in fact, your goal should be to expand your range first and then strengthen.  Don't just keep stretching and "lengthening" tissues!  Read more about your "short hamstrings" here with Jules Mitchell's awesome post.

I opened up a chat with some of my fellow teachers last month inquiring about why we stretch, and I love what my colleagues had to say (Thanks Alex E. and Alexa P.!)  Here's what one of my teachers, the brilliant and fabulous Sarah Court said, "Losing healthy range of motion sets you up for injury.  Stretching is not about trying to change the length of anything, rather you are trying to optimize overall mobility and not lose movement options from lack of use." 

The conclusion?  Stretch (a little bit) to regain mobility and move better, then strengthen and move more.  Stretching the same thing every day?  Maybe not so much, unless you're Stretch Armstrong in the hands of a seven year old. 





Summer Festival (and general life) Survival Guide

Last month, I wrote up a brief informational sheet about self-care and overuse injuries for a summer festival.  While most of you regular readers will be familiar with these concepts, I thought I'd give you the option to read the highlights of the article, and also have the pdf download.  (huzzah!)  

PDF to Download! 

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Did you know?

-Musicians often live with a certain amount of expected pain.  Not to paint a depressing picture for you, but a 1998 Survey of Symphony and Opera musicians by ICSOM (International Conference of Symphony and Opera Musicians) revealed that 76% of musicians during the course of their career had at least one medical condition compromising performance.  As musicians, we tend to underestimate the sheer mechanical repetition needed in order to perform in our jobs-many traditional symphonic works are thousands of measures long, requiring hundreds of notes per minute.  (Remember this post on statistics?)

-Overuse is a blanket term for muscle, tendon, ligament, bone, and joint issues which are induced through repetitive motion beyond typical limits.  Tendonitis is most common, which is an inflammation of the connective tissue that connects muscle to bone.

Prevention

-Move more! Exercising can't undo 6-8 hours of sitting, so add more movement to your day.  Walk more often, take the stairs, carry things- don't take the easy route unless you need to. Your body molds itself like silly putty to the shapes that you put it in-choose wisely (and move diversely)!

- Do simple mobility and stretching every day.  Stretching may not seem like the coolest thing to do at breaks or between rehearsals, but movement can make a big difference in maintaining healthy tissues.  In addition, try to warm up before serious practicing or rehearsals to increase blood flow.  Also keep in mind that when you can't control the amount of rehearsals you have in a given day, self-care should be a priority, not an add-on!

-Use your ischial tuberosities (your sitting bones!).  This Katy Bowman video is my personal favorite for explaining how to sit better, as opposed to sitting on your sacrum.  Poor alignment in sitting (especially if you rehearse more than 6 hours a day) can lead to many other musculoskeletal issues, including back pain and neck pain.

-Get a massage or try self-massage.   If you have residual knots, adhesions, or tight spots in your upper back, consider a serious deep tissue massage, myofascial release, or rolfing session.  Restriction in the trapezius and upper back can affect your whole upper body (shoulders, neck, forearms, etc.).  A good session can restore normal range of motion and increase blood flow as well as remove adhesions in the soft tissue.  Rolling on balls (YTU®, lacrosse, pinky) can also be incredibly helpful as well!

-Sleep more than 6 hours a night. Sleep is when your body takes on cellular repair, renewal, detoxing (!!), and provides rest for your vital internal organs.  When you don't sleep enough, you’re hungrier, more vulnerable to illness, less focused, increasing your odds for injury and disease, and preventing your cells from repairing adequately, which is important when you're playing often.  Sleep often gets sacrificed in the summer for revelry, which is great, until your forearm muscles feel like you've been doing crossfit "musician-style," and your body runs on a combination of all-day caffeine and nocturnal alcohol.

-Drink lots of water. Your body is 60% water, which is essential for cellular operation.  If you're in hot, humid weather, you need to drink more, and if you're moving and exercising in the heat, even more.  Keep in mind that soda, caffeine, and alcohol can contribute to dehydration, and that water helps in the cellular regeneration process.

dB Danger Zone chart!

dB Danger Zone chart!

-Protect your ears in ensembles.  Sounds above 140 decibels cause immediate damage to your auditory sensory receptors, and normal conversational levels are 60-70 dB.  Flutes and piccolo are between 111 to 145 dB, trumpets can reach up to 140dB, and a full orchestra can be between 120-150 dB.  We all know that hearing loss can be permanent, so wear earplugs if you're in the line of fire and ask for a sound shield.  I love the Etymotics brand, but even cheap foam ones can prevent damage.  Your hearing is not only the basis of your musical career, but a primary mode of our verbal communication

    Overall, pay attention to your body, your tissues, and your pain signals.  Pain is your body's way of telling you that something is not working in your movement patterns, habits, or duration of activity.  Shooting pains, numbness, and tingling are warnings of bigger potential issues, and you should stop playing immediately and see a medical professional if these are occurring.  No festival rehearsal schedule is worth long-term tissue damage, nor is a competition, a recital, or any other concert engagement.




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.

 

Sternocleidomastoid- Muscle or Undiscovered Dinosaur?

While it would make an excellent dinosaur name, the SCM, is alas, a muscle.

Sternocleidomastoid: It's a muscle that attaches at your sternum (sterno), clavicle (cleido) and your mastoid process (which is behind your ear), which governs your's head's ability to turn, bring ear to shoulder (side bend), and a few other paired actions.  Why do I bring this mammoth named muscle up? Because it is one of the muscles that can be a serious problem in musicians, especially those of the violin/viola persuasion and flutists.

You can actually find this on yourself pretty easily, if you turn your head and look in the mirror.  

You can actually find this on yourself pretty easily, if you turn your head and look in the mirror.  

He does look pretty relaxed-I'll give him that.  But sustaining this position for hours a day could be tough.

He does look pretty relaxed-I'll give him that.  But sustaining this position for hours a day could be tough.

Forward head posture, which I mentioned on Friday, can be a huge pain (in the neck) but additionally can create muscular imbalance, wherein the muscles in the back of the neck (splenius) can get extremely overworked and overpower the smaller muscles of the neck, such as the SCM.  In addition, the SCM can get overworked on its own if a musician perpetually leans the head to one side in order to play, like this famous dude on the right.  Now that you know that the SCM affects the ability to turn one's head, as well as bring ear to shoulder (lateral flexion/extension), you can see why musicians sometimes have pretty serious neck pain, especially if they excessive clamp while playing a string instrument, overturn their head to the left or right (flute players, hello!), or if they don't take any preliminary steps to keep the head on straight (literally).  If you think about it, an asymmetrical head position starts at a young age for many of us (violin lessons at 6) and for many hours a week, enhances that tightness and restriction on the left side.  (Or right, if you're a flute player).  Simply put, we have to keep the soft tissues of our neck healthy, because we're engaging in a practice that isn't really great for a vulnerable area of the spine.  I like this video, as well as the practices I mentioned on Friday as a way to combat neck crises.


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