Musicians' Health Collective

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

Filtering by Tag: tight muscles

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.

Targeting Tight Shoulders and Hamstrings- Beyond the Stretch

So now that I've revealed the big news...that muscles don't magically grow longer with stretching, let me do some explaining. 

Most people think of muscles as being tight or loose (or open, or something similar).  Tight usually means limited range of motion, loose/open meaning flexible.   (Range of Motion is basically the ability to move at a joint.) To couple that, muscles can feel tight and be strong or feel tight and be weak, and vice versa, loose/open and strong,  loose/open and weak. Review Jules' blog on "You Aren't Tight, You Feel Tight" is this is fuzzy. Does that make sense?  In the end, we're more interested in joint range, i.e., where the joint end range is, in determining flexibility.  We're also interested in having strength in that new flexibility, but more on that later.

PLEASE don't do a forward fold this way, especially if you have disc issues.   Do a stretch on your back and read this Katy Bowman blog .  Note her pelvis is tucked and her spine is rounded, so she's barely stretching her hammies at all and instead tweaking her spine.

PLEASE don't do a forward fold this way, especially if you have disc issues.  Do a stretch on your back and read this Katy Bowman blog.  Note her pelvis is tucked and her spine is rounded, so she's barely stretching her hammies at all and instead tweaking her spine.

Ex.  A woman who runs every day in preparation for a race (please take days off when training, folks!) may have "tight" hamstrings.  She doesn't cross train or stretch much, but does walk to work, and wears high heels, where she also sits at a desk for 6-8 hours a day.   However, her hamstrings may be quite strong and "tight/short" in certain positions because they are propelling her action of running for hours a day.  (And duh, her calves are shortened all day long, which doesn't help!)

A man who sits at a desk every day for 8 hours and then sits on his couch and watches TV after a one hour weight lifting workout (3 days a week) may also have "tight" hamstrings.  However, his restriction may be due to adaptive shortening, in which "A muscle can change it's functional resting length to adapt to the length at which the muscle is habitually used or positioned."  Thus, his hamstrings may be "tight" and weak, or at least much weaker than our woman. 

This teeny image gives you an idea of different ranges of motion for hamstrings- the bottom left corner has the least range, the bottom right has the most.  A typical range for many folks is either of the top two ranges, which will get you through most life activities.

This teeny image gives you an idea of different ranges of motion for hamstrings- the bottom left corner has the least range, the bottom right has the most.  A typical range for many folks is either of the top two ranges, which will get you through most life activities.

So this "tight" hamstring thing is not necessarily just a muscle length issue for either person-it's also a range issue because neither of them are using full leg range of motion (and both of them sit...a lot!).   So using the logic that Jules set forth about stretching , both folks would be benefited most by actually moving more diversely in more ranges of motion, or gaining strength in more range.  What might that look like?

Both would be benefited by walking more often on varied terrain in minimalist/flat shoes (which uses the legs, hips, psoas, calves etc. in different ranges and impacts than running and chair sitting), lunging, squatting, and soft tissue work to break down adhesions (like ball rolling/foam rolling), as well as other movements too.  Both would be benefited by moving to a dynamic desk (standing/floor sitting/etc), even if for an hour or two a day, in which legs would get the opportunity to be at full resting length, rather than consistently shortened by sitting in a chair, bent at ninety degrees.  Our lady in training would benefit from adding cross-training movements to her running, and maybe taking a few days off to just walk, and did I mention ditch the high heels, especially at a standing desk and while walking?  (And read here- I love my standing desk!)

*Time-out: the hamstring muscle group (semitendinosus, semimembranosus and biceps femoris) have a primary function of flexing the knee.  So when the knee is bent, even if passively like in a chair, the hamstrings are passively shortened.  Muscles' primary jobs are to move bones, and they work in agonist/antagonist relationships.  The quads are knee extensors, i.e., they help to straighten out the leg, so constant sitting isn't helping your hamstrings or your quads.  Take a moment to read a bit more and here's more info.*

This image shows someone with restriction in their ability to flex the shoulders, unable to get the arm all the way overhead.  Notice that they are NOT RIB THRUSTING to get their arms overhead.  DON'T DO IT!!!!

This image shows someone with restriction in their ability to flex the shoulders, unable to get the arm all the way overhead.  Notice that they are NOT RIB THRUSTING to get their arms overhead.  DON'T DO IT!!!!

I love having a pull up bar in my apartment for supported and unsupported hanging.  This is also not me but this woman is killing it.  Not that she is NOT RIB THRUSTING.

I love having a pull up bar in my apartment for supported and unsupported hanging.  This is also not me but this woman is killing it.  Not that she is NOT RIB THRUSTING.

So in case you don't care about hamstrings, let's look at musicians, for whom range is usually lost in the shoulders.  Most of us use our arms in the same positions for hours a day without varying the weight or action, and we rarely reach or train overhead.  One range that is often lost is the ability to flex one's shoulders, or basically reach arms overhead (like you would for a push-press or to prepare for a pull up).  Adaptive shortening and weakness will often prevent good overhead position, which often equals rib thrust mania.  (Or at least this is my problem)  What might be a solution?  Stretching isn't terrible (I've discussed some reasons to stretch before) to start, but using the full ROM is going to be most beneficial.   Basically, ask yourself the question- what am I stretching for if I don't have strength in this new range of motion?  If you think of a gymnast or figure skater, they have a huge range of motion, yet it's coupled with extreme strength and control in that large range of motion.  If we just stretch for the heck of it and don't actually use that new range, it's not doing us any good (although it might feel nice).

If a musician like me (with limited overhead range) was a client that I was working with, I'd do some specific ball-rolling soft tissue massage work (targeting the supraspinatus and other rotator cuff muscles of the shoulder as well as the thoracic spine), and then see what the current range is.  Rather than just stretching the shoulders, I'd instead start to move into flexion with a light weight (like a cork yoga block) and see what's possible (lying down to start with zero rib thrust).  If someone has limited range but no injury, another activity could be hanging from a bar supported, perhaps feet on the floor.  For the record, hanging from abar is quite hard, even if it's for 10-20 second increments and Katy Bowman suggests a very humane gradual progression to dead hanging especially if you don't have full range of motion in the shoulders, need to develop grip strength, or aren't ready to jump in on crazy Ido Portal hang/swing/one armed hang extravaganzas.  Read more about it on Ido Portal's blog challenging daily dead hangs.  In addition to helping develop some overhead strength in a range of motion most of us lack, it also feels great, especially if you're anchored at a computer or music stand most of the day!  (Did I mention not to rib thrust when doing overhead work? We want to evaluate your shoulders, not your spine!)

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