Musicians' Health Collective

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

Filtering by Tag: strings

Detangling the Pec Minor: Part 1

With this image from gray's anatomy, you can see the pectoral minor.

With this image from gray's anatomy, you can see the pectoral minor.

When musicians complain about shoulder pain, they often direct their attention (and discomfort) at the arm bone or the back of the shoulder, or scapula region.  But one of the sneaky culprits to shoulder and neck pain, as well as shoulder and arm bone misalignment, is the pectoralis minor.  It's the mischievous sibling to the larger and more well known pectoralis major, which attaches at the clavicle, sternum, and arm bone and lies atop pec minor.  Now the pec minor is of particular interest to musicians (and honestly most desk/computer workers) because when working well, it can help to stabilize the shoulder joint, but when it's short or inhibited, the shoulder and arm bone will slide forward, in protraction and/or internal rotation.  Let's demystify those last two anatomical words first, though.

If you take a look at this man's shoulders, you can see that the one on the left sits on the table. The scapula, or shoulder blade is rooted down, whereas the right shoulder blade is elevated off the table and the front collarbone is higher on the right that the left.  This would most likely be restriction of the pectorals on the right side, which not only pulls the arm bone and scapula forward (protraction), but also can internally rotate the right arm.  What does that internal rotation look like?  In laymen's terms, it means gorilla arms.  

Credit to RES and bodyworker Barbara Loomis for this awesome comparison.  You can see the difference in her arm bones, elbows, and collarbones.  Check out her great work at  Alignment Monkey!

Credit to RES and bodyworker Barbara Loomis for this awesome comparison.  You can see the difference in her arm bones, elbows, and collarbones.  Check out her great work at Alignment Monkey!

Image courtesy of Huffington Post.

Image courtesy of Huffington Post.

So now we have a working understanding of what this muscle group can do to the shoulder, at least in standing.  But how did we get to have restricted pectorals in the first place?  For string players, our right side bow arm tends to be internally rotated and will often slide forward.  If you take a look at this image of Anne-Sophie Mutter, you can see that her right arm is moving forward from her spine and ribs. If you couple that with a lot of forceful playing, extreme pronation in the bow arm (i.e. lots of first finger and thumb pressure), and/or lots of playing at the tip of the bow that can exacerbate things.  In addition, perpetual tremolos in orchestra, i.e. a Bruckner/Mahler symphony extravaganza, especially loud sustained tremolos will ask a lot of the shoulder and forearm.   

After a long week of works requiring tremolo, my colleagues will sometimes ask me why their arm is so tired and achy!  This image shows some bow arm soft tissues that may be affected by our repertoire.  Image courtesy of  Round Earth Publishing.

After a long week of works requiring tremolo, my colleagues will sometimes ask me why their arm is so tired and achy!  This image shows some bow arm soft tissues that may be affected by our repertoire.  Image courtesy of Round Earth Publishing.

So now we have a basic idea of how the pectorals might get short, abused, or overused in string players, but what about with other instrumentalists?  And how might it affect your performance and playing and how can you help restore its natural length and function? More on that next time.

Hypermobility- What is it? Part 1

Picture courtesy of  CoreWalking - can you see how the left leg moves beyond perpendicular?  The ligaments aren't telling the body when to stop moving backwards.

Picture courtesy of CoreWalking- can you see how the left leg moves beyond perpendicular?  The ligaments aren't telling the body when to stop moving backwards.

Whether you know it or not, you probably have students, colleagues, and friends who are hypermobile, whether in larger joints or smaller joints.  Hypermobility, or as we called it as kids, "double jointedness," is a joint (or joints) that move beyond normal end range.  The ligaments (which duct tape bone to bone) are loose and don't offer feedback to the body to say "hey, stop moving here!" It means that the body doesn't observe normal end range for joints because it's not receiving feedback from ligaments. Hypermobile folks end up in all sorts of movement spaces, from yoga and pilates to crossfit and olympic weight lifting, and helping (and identifying) hypermobility can help your music students greatly.

Notice how the standing leg (the right one) is SUPER hyperextended and the elbows are as well.  This yoga pose manifests in many different styles, and in many permutations, but I imagine that in this case, the practitioner is hyperextended to make the pose "prettier" rather than respecting her end range and coming out of the pose a bit.

Notice how the standing leg (the right one) is SUPER hyperextended and the elbows are as well.  This yoga pose manifests in many different styles, and in many permutations, but I imagine that in this case, the practitioner is hyperextended to make the pose "prettier" rather than respecting her end range and coming out of the pose a bit.

Here's an image from  80gladstone  demonstrating hypermobile elbows.  When a student hyperextends the joint (left), they are no longer using muscular energy to support themselves.  This is a problem in music, because we need muscles to support weight and help articulate keys.

Here's an image from 80gladstone demonstrating hypermobile elbows.  When a student hyperextends the joint (left), they are no longer using muscular energy to support themselves.  This is a problem in music, because we need muscles to support weight and help articulate keys.

The most obvious example of hypermobility is in the knees.  Jonathan FitzGordon recently did a post on hypermobile knees, and how they manifest in yoga classes, so let's take a look.   This simple drawing above shows a knee that has locked and gone beyond normal vertical joint end range.  Many people can hyperextend their knees-it's not uncommon.  The risk is when you spend all of your time in this position (standing, yoga-ing, walking, weight-lifting) the body doesn't stop at the end range of the joint, your ligaments are overstretching (if they aren't already), and ligaments are not an overly elastic tissue.  Many people with looser ligaments have always been that way- I remember little kids who could do full splits, lateral splits, etc, without a warmup, because they were just built that way.   Now let's look at how that affects us in the Music and teaching space.

Ouch!  I definitely wouldn't want to load this joint in this position!  Yes, the right thumb is in the right "position" to hold the clarinet in terms of the thumb ledge, but it's not in a great position to hold any weight!

Ouch!  I definitely wouldn't want to load this joint in this position!  Yes, the right thumb is in the right "position" to hold the clarinet in terms of the thumb ledge, but it's not in a great position to hold any weight!

We will all meet students and colleagues who are hypermobile in their hands, which often means that supporting an instrument, pressing keys, and holding a bow will be challenging in different ways.  String players will be familiar with students who can't bend their thumb and hold the bow (their muscles are weak!) or who can't bend their pink on the upper side of the bow.  Wind players may be familiar with the double-jointed thumb, which can cause problems with supporting the weight of the instrument.  Whether it's a flutist's stray pinky or a violinist's dubious bow hold, students of all ages and levels can have issues with hypermobility.  My next post will give some suggestions for what to do with hypermobile students, or how to help yourself!

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