Musicians' Health Collective

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

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Osteoporosis, and Why Your Bone Density Matters

About 54 million Americans have osteoporosis and low bone mass. It affects one in two women over 50! However, daily exercise and movement can help prevent low bone mass.-2.jpg

I recently went through the statistics for search queries on the blog, and one that came up was "violin and osteoporosis," which I thought was worth addressing.  We typically think of osteoporosis as something that old fragile ladies get, but frankly, it's something worth thinking about for both men and women, especially as we move past the peak bone density period of our twenties.

Simply put, osteoporosis is weakness of the bones, which causes them to be more brittle and susceptible to breakage.  The precursor to osteoporosis is osteopenia, meaning low bone mass.  Our bones are in a constant cycle of regrowth (ossification) and resorption (removal).  These two processes remain in balance throughout our youth, but as we age, there is often more resorption, and less ossification.  This is turn can cause a reduction in bone mass (osteoblast cells are less active than osteoclasts).

When I was at my doctor's office, I took a few pictures of this model spine, which shows a range of spinal issues.  Focus on the bottom three, (green, pink, and yellow), which compares bone density for osteoporosis (green), osteopenia (pink), and normal (yellow) bones.  Notice how large the porous surfaces are with the osteoporosis?

When I was at my doctor's office, I took a few pictures of this model spine, which shows a range of spinal issues.  Focus on the bottom three, (green, pink, and yellow), which compares bone density for osteoporosis (green), osteopenia (pink), and normal (yellow) bones.  Notice how large the porous surfaces are with the osteoporosis?

There are many factors that affect osteoporosis, from genetics, diet, and exercise, to hormonal levels due to cancer treatment, prescription medications, thryoid issues, or other endocrine dysfunction.  Osteoporosis affects one in two women, and one in five men, so this is definitely not a ladies' disease.  I became acquainted with osteopenia a few years ago when I was being treated for my pituitary adenoma (non cancerous pituitary tumor), which completely threw all of my hormones out of whack, essentially putting me into the hormonal cycle of menopause.  Our sex hormones (as well as the hormone thyroxine) stimulate bone cell growth and osteoblast activity.  This means that low estrogen and low testosterone negatively impacts your bone density, regardless of age or gender.  This also means that if you have a thryoid issue (most commonly underactive thryoid or hypothyroidism), and you take medicine to balance your hormones and TsH (thryoid stimulating hormone), you are also at risk because the meds you take may either overbalance or underbalance said hormones.  This is also true if someone has had hormonal treatment for cancer, i.e., hormone replacement therapy for breast cancer, ovarian cancer, etc.  Osteoporosis is a definite secondary risk from many forms of cancer and subsequent treatment.*

*Quick aside: before I was diagnosed with my tumor two years ago, I knew very little about endocrinology.  Now, a few MRI's, many articles, and many blood tests later, I know a bit more.  I highly recommend learning about your own health issues as much as you can, so that you can have dialogues with your doctor about medicines, side effects, long term care, etc.  It's made a HUGE difference in my treatment.*
This image is a bit more difficult to process, but do you see the shape of the vertebrae is actually different?  The top four vertebrae are all compressed, whereas the healthy bone on the bottom is normal shaped and the disc isn't compressed either.  The top two vertebrae are fractures (anterior wedge and compression) and green is osteoporotic and pink is osteopenic.

This image is a bit more difficult to process, but do you see the shape of the vertebrae is actually different?  The top four vertebrae are all compressed, whereas the healthy bone on the bottom is normal shaped and the disc isn't compressed either.  The top two vertebrae are fractures (anterior wedge and compression) and green is osteoporotic and pink is osteopenic.

So why am I discussing this?  Well, musicians (and frankly most people) tend to be sedentary (risk factor for osteoporosis) and our occupation forces us into a sitting situation for 6-8 hours a day.  Our peak bone density occurs in our mid twenties, which means that most of you lovely readers have already peaked!  As we begin to work towards our thirties, forties, fifties, sixties, and seventies, regardless of gender, we need to take care of our bones.  In addition, many musicians don't challenge their upper body strength out of fear of injury which doesn't help muscle or bone strength.  In looking at aging populations, one of the biggest risks is falling and balance, in conjunction with osteoporosis.  Hip, wrist, and spinal fractures are a serious risk which could put a musician out of commission for months to a year.  The good news is that bones also grow in response to mechanical stress, so daily exercise in a gravitational context (not swimming or cycling), walking, and weight bearing activities are really beneficial for your bones.  Osteocytes build bone in response to stress of 72 seconds (according to Dr. Loren Fishman), so for example, if you hold a plank for 72 seconds, you are hypothetically fortifying your upper body bones. If you do standing lunges, squats, and other body weight exercises, you are also fortifying your bones.  Since this is an isolating research study, I would imagine this applies to more dynamic movements such as walking, running, yoga, pilates, weight lifting, and all body weight activities. Biomechanist Katy Bowman writes that osteoporosis is not an all-body disease, but often restricted to specific location which also lacks movement and loading:

  • Ribs(This could serious affect breathing, which is a major issue!)
  • Wrists (If you're a musician, this is particularly scary)
  • Vertebrae (Hello, back issues)
  • Head of the femur (top of the thigh bone)

From a musician point of view, we want to keep our bones healthy and prevent fractures to our axial skeleton (spine, neck, sacrum, etc.)  Healthy bones permit a long lifetime of music-making.

Want more resources?

Katy Bowman has a few great articles on osteoporosis as well as a great podcast on bones.

Buff Bones is a great exercise program developed by Rebekah Rotstein addressing osteoporosis and osteopenia.

Jill Miller writes on Osteoporosis

Yoga For Osteoporosis in the Huffington Post: I don't love the demo pictures in terms of alignment, but the content is solid.

Why Astronauts Get Osteoporosis, by Brooke Thomas (Also interesting to think about in the context of the film Gravity, and why it wouldn't be possible for Sandra Bullock to swim/crawl/etc)

Walk It Like It's Hot

Neon pink vibrams are optional.  Natural terrain walking for the win!

Neon pink vibrams are optional.  Natural terrain walking for the win!

People often ask me, "If I can do just one movement thing to improve my overall health, what would it be?"  And although there are a million great possible answers (manage stress better, meditate, self-massage, move more, sleep more, eat plants), I usually answer that you, me, and everyone we know should walk more (stats on that here).  Last year, I decided to walk 2015 miles ( I really got to 2038) and see how it affected my health, and honestly, it was great.  It got me out in nature more often, my back pain decreased, my hip strength increased, my foot and calf mobility increased, and I listened to SO many podcasts and audiobooks.  I learned a ton and I'm still learning lots.  In the words of Levar Burton and Reading Rainbow, don't just take my word for it:

1) Walking is a foundational human movement, yet our modern society has essentially made it easy to skip walking as frequently as possible.  You can park a car close to the market/post office/pharmacy, walk 10 feet from your car into the store, and back out.  Many communities don't have as many public transportation options, so people rely heavily on their cars for transportation rather than walking to do daily tasks, such as going to the post office, market, etc.

There are definitely downsides to fitbits and other technology, and I don't wear mine in the house, while practicing, or when I'm not walking, but it's helpful to keep track of miles for the year, especially if you don't want to use "Track My Walk" on your phone.

There are definitely downsides to fitbits and other technology, and I don't wear mine in the house, while practicing, or when I'm not walking, but it's helpful to keep track of miles for the year, especially if you don't want to use "Track My Walk" on your phone.

2) Walking doesn't demand fancy equipment, high tech shoes, expensive workout clothing, or other gear (fitbit or other tracker not needed!).  Although walking in one's own neighborhood may not always be possible depending on the time of day, weather, safety, etc., it is something that is versatile and that can be (hypothetically) done anywhere.  (Just make sure you're not walking in heels, heeled boots, etc...)

3)  Walking can be social- it's an opportunity to spend time with your children, partner, friends, and family, whether it's in your neighborhood or out in nature.  Hitting two birds with one stone (social time plus movement plus nature) is always a win.

4) Walking is a movement that can build bone density and prevent osteoporosis, as opposed to cycling or swimming, which are not weight bearing motions working in relationship to gravity.  Women in particular, whether they are young or old, need to be doing movements that build local bone density, especially if their family has a history of osteoporosis.  Here's an article from the NY times about bone density and cyclists

5) Walking is a less intense physiological experience than running, putting less strain on the knees, heart, pelvis, and spine, especially if you only run on pavement.  (More on that another day)  Walking is a gentler way to get in daily movement, develop endurance, improve circulation, strengthen muscles, and support joints.  It obviously burns calories, and there are varying opinions about whether walking burns the same amount of calories as running.  To the running vs walking debate, I would say it depends on where you're walking/running, how you're walking, how you run, what shoes you wear, surface, grade, etc.    (i.e. run 3 miles vs walk 3 miles)

6) Walking can improve symptoms of hypertension, cholesterol, diabetes just about as well as running, which is terrific for populations of people who are not runners, who may not be able to run, may carry excess weight on their frame, or who want to improve health without potential risks of high intensity cardio.  Also, walking can be an awesome stress reducer- I often feel much better after a long walk.

Getting outside and off of the pavement means you might see actual animals, which is always a plus.

Getting outside and off of the pavement means you might see actual animals, which is always a plus.

7)  Walking in flat, minimalist shoes on natural terrain can help mobilize the small bones of your feet, strengthen the small muscles in your feet and calves, and strengthen often ignored muscles in your hips, legs, and lower limb.  Most of us walk on pavement, so integrating different terrains (rocks, sand, soft earth, etc) will actually change the loads to your feet profoundly!  Read Katy Bowman's blog on this here!

8) Walking in flat shoes on natural terrain will also challenge your in terms of grade, i.e. hills up, grade down, etc.  When we typically walk on sidewalks, there are very few hills and variations in gradation, which limits our ability to strengthen our glutes and hamstrings, as well as challenge our ankles and feet.

9) Walk while doing other things- I love to make phone calls while walking or listening to podcasts and audiobooks.  It's a great way to do things that need to be done while integrating some movement into my day.  Also, where can you walk to do errands?  Can you walk to the post office, coffee shop, yoga studio, gym, farmer's market, or work?  Get two things done at once!

Even though my dog is quite blind (and sometimes runs into things), she loves going outside for walks.  She also loves sleeping on pillows.

Even though my dog is quite blind (and sometimes runs into things), she loves going outside for walks.  She also loves sleeping on pillows.

10)  Walking is beneficial for everyone.  Whether you're a cyclist lacking bone density, or a heavy weight lifter or cardio enthusiast, walking is a different physical and physiological exercise than "working out."  It's what Katy Bowman calls a movement macronutrient- something essential for human life.  For folks working with organ prolapse, pelvic floor disorder, and diastasis recti, looking at alignment in standing and walking is a MUST. Also, running is not the same physiological experience as walking and even if you're an amazing runner, you may have some body blind spots because of your lack of walking!  If you're a runner, walking on natural terrain will be a completely different experience than running a race on pavement or using the treadmill. 

With that, I'm going to go walk my mostly blind dog around the block.  (PS.  She loves walks)


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Blogroll: What I'm Reading on the Internet

Rather than paraphrase some of the more interesting articles about sitting and its dangers, I figured it'd be easier to just make a list of some of my favorites.


"Is Sitting Killing Me?" by Alice Park, Time Magazine.  This awesome article addresses "NEAT: non-exercise activity thermogenesis," AKA. all the movement you do which is NOT exercise.  Stairs, walking to work, standing desks...it's time to get more movement into your life, not necessarily more exercise.

 

"Stretching Doesn't Work (The way you think it does)" by Brooke Thomas.  We talked about how stretching isn't going to make everything "longer" in your body.  Let's hear Brooke's excellent logic on how stretching really works.

 

"Walking is the Superfood of Fitness"   I'm a huge fan of walking, as many of you know.  You can skip a workout, but get in a walk.  If you do no other physical activity in your life, please walk.  It's incredibly important for you body.  Period.

 

"Thinking Outside the Classroom Chair," by Katy Bowman.  The problem with sitting is not only the frequency, but also that we sit the same way ALL the time.  What if you sit differently?  On the floor?  On a cushion?  Even on the couch?

 

"What Are We Doing in Asana," by Matthew Remski.  (AKA. WAWADIA).  As a yoga and movement teacher, I appreciate that Matthew is looking at the truth behind yoga's supposed therapeutic postures.  Not everything is as it seems, and even if you're an on again off again yoga person, it's a great project to peruse. 

 




I Turn Out My Feet-So Now What?

If I don't think about how I stand, this is what happens.  My right leg is basically pointing forward and my left leg/foot turns out.  You can also see that one's toes don't necessarily point forward-they may deviate to the side, so "toes point forward" is not the most accurate of cues.

If I don't think about how I stand, this is what happens.  My right leg is basically pointing forward and my left leg/foot turns out.  You can also see that one's toes don't necessarily point forward-they may deviate to the side, so "toes point forward" is not the most accurate of cues.

1.  Take a look at your feet.  It can be helpful to compare this with a wall, line, etc.  First, are your knees pointing in the same direction as your feet?  Where are your toes in relation to everything else?

2.  Place a book or block between your feet to start to test it out.  This is not your true parallel, because you're bringing the whole inner line of the feet together. (I visualize feet as more triangular than rectangular, so if you bring your heels together, your toes turn out slightly).

Getting better-now my "toes point forward", but if I look at my knees and hips, they're turning out slightly.

Getting better-now my "toes point forward", but if I look at my knees and hips, they're turning out slightly.




3.  Now try to bring your outer edges of your feet to parallel, using the book as a spacer.  What that will do is demand that your heels will separate slightly, and the inner edges of your feet will touch the book.  That is your truest approximation of feet point forward.  If the book/block concept doesn't fit your bones (you might be smaller or larger than me), than try a different size book.  (A yoga block is about the size of a Harry Potter Book.)  In addition, try these different spacing activities and see how it feels not only in the foot and knee, but in the hip and spine.

Here, my heels separate slightly from the book, the front and insides of my feet contact the book, and the outsides of my feet are pretty close to parallel.  This is my optimal stance.  (I also could use a pedicure.)  Can you see how my left big toe deviates slightly to the left?

Here, my heels separate slightly from the book, the front and insides of my feet contact the book, and the outsides of my feet are pretty close to parallel.  This is my optimal stance.  (I also could use a pedicure.)  Can you see how my left big toe deviates slightly to the left?

Why am I slightly obsessed with this principle?  Because changing the way I stand and walk has decreased any pain or discomfort in my feet, knees, and hips considerably, and I do believe that the way we teach our students to stand will affect their long term movement patterns.  Feet/knees straight is simply a good foundation towards achieving neutral pelvis, neither internal nor external rotation in the thighs.  There are good reasons that one may not be able to do this, and you would probably already know this based on your medical experience (PT, pediatric diagnosis of bow leggedness, tibial torsion, hip retroversion, etc.), and later this week, I'll detail some of the movement patterns that would prevent someone from doing this easily.  For the public at large, neutral rotation of the thighs is a soft tissue issue, and a habit, rather than a structural restriction.  What that means is that the muscles of external rotation (in the hips and thighs) may be stronger or tighter than the muscles of internal rotation, and that the body is not used to standing in a neutral position.  

In addition, music making is an incredibly complex and intellectual process, and naturally, we might be focused on what's going on with our instruments, baton, etc, rather than our feet and legs.  Having a solid foundation in the lower body has been incredibly helpful for me in stressful performance situations, and also gives me a sense of stability in confidence in other movement disciplines.  When we can make music from an awareness of the whole body, it creates an embodied performance that is palpable and powerful.  Just as Andrea wrote in her most recent post, this is also process of exploring your own movement patterns, and just becoming aware of your habits and tendencies is incredibly valuable feedback.


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