June 1, 2012
Did you know musicians have the highest work injury rate of any profession? According to William Dawson in “Fit As A Fiddle: The Musician’s Guide to Playing Healthy”, it’s something like 90%. I don’t know about you, but I really don’t think that’s acceptable, and yet, the fact remains that most of us play in pain. Most of us develop pain or injuries as a result of our playing our beloved instruments.
The good news is it is largely preventable. A warm-up should include more than just long tones. In fact, I would say that a physical warm-up could be just as important if not MORE important than your practicing warm-up! Why am I so sure? Well, first off, if you are in debilitating pain, it hurts every time you raise your arms, you can’t feel your fingers, have tendonitis, carpal tunnel, thoracic outlet syndrome, piriformis syndrome, etc. etc. etc. it really won’t matter how beautiful your soft high notes are, will it? You deserve to enjoy playing your instrument and when a physical warm-up takes just as much time if not less than a playing warm-up and will save you pain and a possible job in the future, why neglect it? Your body is your first instrument, you and must learn to take care of it, so it will continue to take care of you. I plan on writing some more detailed posts about specific stretching and warm-up routines for various areas of the body in the near future on my personal blog later, for today, I would like to talk about foam rolling.
Foam rolling is using what looks like a big, hard pool noodle to roll your body across and give yourself a self-massage. The benefits are numerous. Besides feeling good, releasing endorphins and increasing blood flow, lymph flow and increasing circulation, foam rolling may help save your playing career!
Another name for foam rolling is self-myofasical release, or SMF. Besides the above benefits, two of the best benefits are that it releases knots or adhesions in the fascia that surrounds your muscle tissue and improves your joints range of motion. You’ve heard of knots, they’re the painful things massage therapists work on when you go see them. They get pressed on and what happens? It hurts! But then, ah….it feels so much better. While a therapist will always be your best and most thorough option, you just can’t afford to go every day, so let me introduce you to some inexpensive options that you can use on your own and will even fit into your flute bag!
A quick anatomy lesson; some of the upper back muscle that give flutists the most problem are: the rhomboids, levators and teres major and minor. We are going to concern ourselves with the rhomboids. The rhomboids bring the shoulder blades in towards the spine. What happens on the left side of your body when you play your flute? The rhomboids get stretched as your arm moves in front of your body…and then you hold it there. This can lead to an imbalance between your right and left rhomboids and cause the left to be especially weak. Besides strengthening the rhomboids (another article for another time) you can perform SMF on the “trigger points” on the rhomboid. Trigger points are the points of most intense pain – the areas your massage therapist would concentrate on. The exact reason for them is up for debate but here’s what you can do about them: find the most tender spot with your roller of choice and when you get right in the belly of the trigger point (aka: the most painful spot) hold the roller on that spot for a minimum of 20-30 seconds. You may feel the muscle begin to spasm a little bit, but then it should release you will feel a wonderful feeling of release, increase in your range of motion and less pain.
A typical foam roller can be used for this, but as this is a smaller muscle and much deeper, I suggest a couple of smaller rollers. You can use a lacrosse ball or even a golf ball if you really ambitious, but a tennis ball is the cheapest option. But if you want to get something that will not disintegrate as fast as a tennis ball and is just as small, you have a few more options.
- Spikey ball
Both are small enough to keep in your flute bag with no issue. I recommend using either before your practice sessions and sometimes after sessions or any time you experience pain. Take either device and put it on the wall behind you. Lean up against the wall and going about an inch at a time, roll the area until you find the most tender spot, and then hold for 20-30 seconds before going on to the next area. If you do not feel anything the first pass, go over the area 2-3 times and you might find an area later.
Follow this up with some shoulder blade squeezes to get the rhomboids used to their proper regained range of motion and you are ready to play!
If you would like more information on what can be done to help you with your specific playing related pain, please don’t hesitate to contact me. I’m here for you – happy playing!
- Rhomboid Major and Minor Trigger Points (gustrength.wordpress.com)
- Rolling in the Deep (crossfiteverett.com)
- battles with the evil foam roller… (70point3andme.wordpress.com)
- What is Trigger Point Therapy? (massageenvy.com)
- The Benefits of Massage (heallovebe.wordpress.com)
- Scalene Muscles Trigger Points and Thoracic Outlet Syndrome (gustrength.wordpress.com)
May 12, 2012
When someone says to you “you need a strong core” or “you need to train your core”, does that leave you scratching your head in confusion? I mean, what IS your core, anyway, and what on earth does it do? Is it your insides? The middle of your body? Your diaphragm? Let me help you clear up all the confusion.
The core, in its simplest form, is actually the area of your body called the torso – therefore, not your arms, legs or head. These aren’t just your abdominal muscles; there are LOTS of other muscles that make up the core. In fact, some of the key players to core strength are in your back and lower back.
There are an awful lot of muscles in your core, and each one plays a role in how well you play your flute. Yes, that’s right, your hip flexors, your back muscles, your abs; all those muscles have an impact on how you play. How is that, you ask? Well, the easy way to explain it is that all your muscles work together in any activity you do.
- Standing uses your core muscles to keep you balanced and from falling over.
- Driving uses more than your arms; your core is heavily involved. An indication of core weakness is pain in your hips or low back when you get out of the car.
The muscles in the front (your abs) serve to pull your body forward. These are the muscles with which you are probably most familiar, and as you know, spending most of our day in a bent over position works them plenty. What this shows is that your back muscles may become weak from the forward-pulling motion of your abs. To have a strong core, this means that you must train your body to resist forward flexion and side to side twisting.
So how does this relate to playing your flute? Like I mentioned before, you don’t just use your arms to play the flute. Remember that old song “the head bone’s connected to the….neck bone” etc.? It’s true. Your body works as a whole. It takes lots of different muscles to lift your arms, turn your head, hold up a flute and breathe to play. And some of those muscles will get tired. When this happens, other muscles take over. If this goes on too long, you get what are called muscle compensations and imbalances, meaning that some muscles become weaker and allow other muscles to do their jobs for them. This can lead to pain.
Each muscle is made to do a job whether that is its own job, the job of being a synergist (helping other muscles do their jobs) or an antagonist (the opposite of a muscle). For example, your hip flexors are antagonists to your gluteus muscles. If your hip flexors get too tight with too much sitting, your gluteus muscles become weak, eventually allowing other muscles (your hamstrings) to do the job of the glutes. What happens then? Your knees could hurt, or maybe your low back hurts from the stress of too much tightness in the front. When your low back hurts because it is weak, this can translate to a weak upper back. If your upper back is weak, it cannot support your arms which are doing a really hard job of holding up your flute, so when your arms tire, you’re just in pain everywhere, all because your hips are too tight, and guess what? They’re part of the core!
So what to do? I think by now we’ve established why you need a strong core to play. When the body works well as a whole, you can play longer without compensating. There are lots of good exercises to help with core strength. My favorite exercise is the plank.
This can be progressed by lifting an arm or a leg, putting your feet on a bench or arms on a ball, or adding weight on your back, and can even be done on your side. The goal is to keep your hips in line with your shoulders, so your body looks just like a plank; a board. Even with the progressions: do not twist your hips or sag in the middle. Hold for 30 seconds or longer, rest, and repeat.
Another of my favorite core exercises are 1) The Anti-Rotation Static Hold and its variation 2) Pallof Presses. These are just fun, and it’s a great way to work your entire core without having to do a single crunch, or sit-up and if you have bad shoulders, these are an excellent choice without putting your shoulders into a compromising position.
Stand perpendicular to a cable station with a weight stack or a pole to which you’ve wrapped around a band. Grasp the band or handle, pull it in front of you and then push it out in front of you, without twisting. If you hold that position, that’s the static hold. If you push it out and bring it back, those are Pallof Presses. The goal with both of these is to avoid twisting (hence: anti-rotation) which you’ll feel all down the middle of your body. Make sure to choose a heavy enough weight so that the exercise is challenging.
This is a video of the Pallof Press:
If you hold the weight out without bringing it back, again, that is the Anti-Rotation Press.
If you are looking for a program of strength training that will train your core from every conceivable angle and get your entire body stronger in the process, I highly recommend a book called “The New Rules of Lifting for Abs” by Lou Schuler and Alwyn Cosgrove. I’ve done the whole program myself and not only was it fun, I saw my strength increase by leaps and bounds! They actually have a brand new book out called the “The New Rules of Lifting For Life”. I just got it today and intend to read through it soon, but the gyst of it is that it is geared for non 20-yr olds, more towards middle agers and people who want to learn how to program their own workouts.
If you would like more exercises and more information, I actually have a longer blog post I’ve written about it with videos here: http://fluteangel.wordpress.com/2011/03/04/3-exercises-1-for-core-strength-and-stability/
As always, I have spots available for long distance training where I can write you a program to strengthen your core, improve your endurance and help you learn to play without pain. You can find me via my website: www.MusicStrong.com and I’m always around on Face book: www.facebook.com/MusicStrong. Come by and say hello, or send me an email with your comments and questions to firstname.lastname@example.org I look forward to hearing from you!
Today I bring you a post from Coach Nick Tuminello. He has written a whole series on the rhomboids, lower traps, and all those key areas that can be problem spots to musicians and desk jockeys alike. Whether you spend your day locked in a practice room or locked behind a desk and yearn to have strong shoulders and a pain-free back, this article is for you.
I can’t highly recommend this series enough. The rhomboids are a muscle that has become chronically stretched and weakened in our “bent over” society: when one bends over a steering wheel, table, computer or music stand the arms pull forward stretching the upper back muscles (and the rhomboids) forward when their main job is to contract and pull the shoulder blades BACK. This can cause weakness, pain and ultimately lead to injury.
The YTWL is a warm-up that I have been seeing and using for quite a long time, sadly, I hardly ever see anyone in the weight room using these movements and if I do, they do them incorrectly. Read and learn and if you want more detailed information he has a whole series on his blog, but he sums it up pretty nicely here.
August 10, 2011
What are the lower traps and what do I mean by activate? This is by no means an exhaustive, comprehensive post, but this should give you a general idea.
There are three parts of the trapezius muscle: the upper fibers (used to bring your shoulders to your ears), the middle fibers that bring your shoulders up and also inward, just like the rhomboids, and the lower fibers (that pull your shoulder blades downward.) If you will, try a little exercise with me for a minute: pull your shoulder blades down. Kind of an odd feeling, isn’t it? When was the last time you remembered performing this kind of action? Probably not very recently, as we don’t spend a good deal of time with our shoulder blades back and down….unless we’re doing a good stretch because we’ve been sitting at the computer for too long.
Now, lift your shoulders towards your ears – fairly easy? This action is performed readily when the “fight or flight” syndrome is engaged; pulling our shoulders towards our ears is a protective mechanism. What else feels tight when you hold your shoulders there? Well, if you hold your shoulders there long enough, you might feel several things
- tightness at the base of your neck
- a pain or pulling in your rhomboids or that vague area somewhere “in between my shoulder blades”
- your chest feels sore from contracting
- you begin to feel a pulling soreness along your rib cage
and several other things. What happens all too often is that the “shrug mechanism” is seen in a lot of people’s posture today. Our more sedentary lifestyles coupled with movements that encourage a protruding head and neck and arms forward posture have led to an epidemic of sorts of “bad posture”. I say “bad” because really, what we get is altered posture due to muscle compensation.
This is one of the reasons I do not advocate anyone (except bodybuilders who are training for size and symmetry) include shrugging movements in their weight training regimens. Most of us, who train for function and stability (and even those of us training for size) need to be focused on the middle and lower fibers of the trapezius.
When the upper traps are chronically activated, this can lead to dysfunction in the form of the lower (and possibly middle) traps becoming weakened to the point of “sleeping”. This term is used not in a literal sense but to describe the problem of muscle imbalances caused by the upper traps being chronically activated, which causes the lower trapezius muscle fibers to not fire properly.
What to do: Activation Exercises
First off, as stated in several previous posts, you must first stretch what is tight. In this case, that can be several muscles: the pectoralis major and minor muscles (chest), levator scapulae and scalenes (muscles in the neck) are the ones I would stretch first. These can be accomplished with a doorway stretch (at 90 degrees to hit the pec major and with the arm extended to hit serratus and pec minor) and the specific stretches for levators as seen in the previous post: The Flutist’s Pain Points
Once the tight muscles have been stretched (also called autogenic inhibition – or static stretching) one can move into activation exercises: which could also be called active-isolated stretching. This is done by a process called Reciprocal Inhibition which uses agonistic and synergistic muscles to dynamically move the joint into a range of motion. These stretches are done for 1-2 sets of each exercise and hold each stretch for 1-2 seconds for 5-10 repetitions.
The lower and middle traps are vital for shoulder stability, so doing exercises to ensure they are doing their job is vitally important. The first rule of strength training form is to retract and depress the shoulder blades. This not only ensures that the middle and lower traps (as well as the rhomboids) are active and functional, it inhibits upper trap, levator and other compensatory muscles from taking over. Use this motion any time during the day as an exercise on its own, and then use it during strength training sessions to make sure your shoulder girdle is stable and lower traps are activated.
Some excellent exercises for activating the lower traps (and rhomboids – as by now you can see they can be synergists) are wall slides, soup can pours, Face Pulls, Prone lower trap raises and LYTP’s. The primary movements, as discussed before, are Adduction (retraction) and depression. This website lists some excellent exercises, shows their movements and gives more anatomical descriptions.
This is by no means an exhaustive list, but a few suggestions on some exercises you can do to “wake up” those lower traps. For a warm-up, I might do something like this:
- Active Pectoral Chest Stretch (major and minor – 90 degrees and extended) 1-2 setsx5-10 reps each. Hold 1-2 sec.
- Wall slides 1-2 sets of 5-10 reps
- Arm circles 1-2 sets of 5-10 reps
- Scapular pushups or dip shrugs 1-2 sets of 5-10 reps
- LYTP’s on stability ball or bench
- Prone lower trap raises on incline bench
By now, your lower traps should feel a pleasant “burning” or tingling sensation, letting you know that the muscles are beginning to fire. After this, I would probably follow up with a few rotator cuff exercises to help with shoulder stability. In fact, Diesel Crew has put out an excellent circuit for “shoulder rehab” that you might want to check out. You can sub it in for the circuit above. (Always check with your doctor or a qualified medical professional if you have any shoulder injuries, issues or concerns before attempting any of these exercises.)
(By the way, I LOVE the pull up retractions!) And flutists (and other musicians) you should pay special attention to this video! These are great exercises to perform before practicing, or any other time of day you want to counter balance the effects of playing your instrument.
From there, with whatever workout I was doing, I would make sure to include exercises that engage the lower traps and throw in one or two exercises to help strengthen the shoulder girdles, my favorite exercise being face pulls. These are very easy to do incorrectly if the shoulder blades are not depressed and retracted.
The list goes on…
There are lots and lots of exercises to increase shoulder stability and when you make a regular habit of incorporating these activation exercises into your programs, you will not only see increased stability, but an increased range of motion, a possible decrease in pain and a possible improvement in upper thoracic posture.
Make sure to include lower trap activation exercises in every warm-up if not each workout! Please let me know how these exercises worked for you and your own experiences!
- Identifying Shoulder Pain – Part I (innovativeperformanceandpedagogy.wordpress.com)
- Shoulder Pain Part 1 (fluteangel.wordpress.com)
- The Flutist’s Pain Points (innovativeperformanceandpedagogy.wordpress.com)
- Shrugging at Shrugs (stephenholtfitness.com)
- Best Exercises for Stretching the Scapular Muscles (brighthub.com)
- Stretching ADEQUATELY Before/During/After Playing (innovativeperformanceandpedagogy.wordpress.com)
- Identifying Shoulder Pain Part 2 – What To Do About It (innovativeperformanceandpedagogy.wordpress.com)
June 17, 2011
Ask almost any flutist that has pain brought on by playing, and odds are they will mention one of these sites as giving them trouble: wrist, upper back (between shoulder blades), shoulder area or lower back. Sometimes the problem is that the pain is in ALL of these sites.
Studies have been done, but the results are inconclusive as to the results of what causes pain. A study I read recently studied the “History of Playing-related Pain in 330 University Freshman Music Students”. The interesting point is that MOST of the students had pain brought on by playing. The frustrating point was that the study was inconclusive as to the cause of the pain.
I have my own hypothesis, however, because this study did not cover my area of expertise: strength training. This is what the study found:
- More students did than did not exercise, but pain occurred in 79% of the exercisers and in only 76% of the sedentary. Data were collected though not analyzed regarding exercise type; jogging appeared to be a favorite, as was the use of a variety of exercise machines
- Most of the pain problems reported by instrumentalists are associated with the musculoskeletal system
- Several factors have played into the lack of regular exercise for musicians. First, those who start their instruments early in life…often have been warned of the potential injury that might befall especially their hands and fingers by participation in athletics. This avoidance behavior becomes habit as they grow older.
- There apppears to be an association between poor conditioning and musculoskeletal complaints, and vice versa; those who do have a regular exercise routine appear more resilient.
- When asked about “regular exercise” …our definition for inclusion here was exercise of at least two times per week for a minimum of 30 minutes. We did not differentiate between exercise modes, but just from casual scanning of the data, jogging was by far the most frequent activity, followed by some kind of machine and/or light weights and biking. A minority did heavy resistance weight training, swimming, soccer and/or basketball.
It is GLARINGLY obvious to me what could possibly be the cause of so many musician’s pain, here, but this was not covered by the researchers.
- The type of stretching done, is probably out-dated, static stretching, which has been shown to be more detrimental than helpful
- Jogging is a favorite activity….this does NOTHING to help weak muscles. If you play an instrument held in front of your body (aren’t they all?) then your body is forced to compensate after the primary muscles holding up the instrument fatigue. Thus leading to pain.
- The MINORITY did heavy resistance training and soccer, swimming and basketball – sports that require a high degree of movement.
Can you see the pattern here?
So getting back to the flutists’ pain points
What are the points of chief complaint? From what I have heard (though if you have another spot, please leave a comment below!) these are the most common
- upper back
- lower back
With the exception of the wrist, the other three points are located on what we call the “posterior chain” This is the back half of the body, responsible for a lot of pulling movements and fighting against the pushing movement of the front of the body, including keeping the body upright. If your posterior chain muscles are weak, it causes them to stretch.
You sit all day, in rehearsals, driving, typing, practicing. You probably slouch, meaning your chest comes forward, your abdomen caves in and your back rounds. You are not balanced on your sit bones. Your shoulders round forward. Your head protrudes.
What does this lead to?
Try taking that posture for awhile and I bet the answer will be:
- my neck hurts
- my upper back hurts
- my hips hurt
- basically, everything on the back half of my body HURTS!
Can you see how this posture, practiced day in and day out is compounded with holding a heavy instrument (or maybe your instrument isn’t heavy but after several hours of playing it becomes heavy to you) can wreak havoc on your body?
The part you’ve been waiting for! You can see where the problem lies, by now, I hope. Weak posterior chain can equal pain. What to do? Strengthen it! Let’s take this on a spot by spot basis.
If your wrist hurts, there can be several causes, some of which may not have anything to do with your wrist, but may actually be a symptom of poor upper body posture, shoulder position, etc. Assuming you play an instrument that puts your wrist in somewhat of a contorted position (flute, guitar, violin, etc.) there are some stretches you can do. Hold each for a count of 10, and follow with movement. It is very important that after you do a static stretch (a stretch you hold without moving) that you follow that with a dynamic stretch (a stretch that involves movement).
These are stretches and of course there are exercises you can do to increase your wrist/grip strength. However, I’m not sure that that is necessary, as my guess is that the reason the wrists hurt has more to do with being tight and needing to be stretched due to being in an awkward position for long lengths of time, rather than being weak. However, grip strength is important when it comes to lifting weights. Diesel Crew has a lot of information on improving grip strength.
This area could take all day to address, and I have in two posts and a guest post by Dr. Perry. For detailed information see Shoulder Pain Part 1, Shoulder Pain Part 2 – What to Do About it, and Dr. Perry’s Post: Shoulder Pain Secret.
The chief culprits of pain are the rhomboids (the muscles in between your shoulder blades that work to pull them together), lower traps (pull shoulder blades back and down) and rotator cuff muscles. When you lean forward with a rounded posture, or have your arms extended in front of you for a long time, these muscles that do the pulling in your upper back get stretched the opposite way and get kinda angry about it. They are designed to pull the shoulder blades back, but if you do not strengthen these muscles, if they do not get used the way they were intended. You get pain.
I think this is the biggest problem area among musicians and the most overlooked!
Strengthen your rhomboids and upper back by doing pulling movements and see if your pain doesn’t improve, not to mention your posture!
My favorite exercises are:
Lat Pulldowns/Pull ups, any type of rows (inverted, seated, barbell or dumbbell) and exercises for the rotator cuff: soup can pours, prone lower trap raises and wall slides. You can see all three of the rotator cuff exercises in Shoulder Pain Part 2.
Before doing any of these exercises, however, it’s not a bad idea to stretch the muscles that are tight, before strengthening the muscles that are weak. That’s another post for another day. :)
Lat pull downs/Pull ups.
Good form BAD FORM!!!
(Coaching cues – keep spine neutral – curve in lower back, no leaning backwards, and keep shoulder blades down)
The big thing to remember here is to that before and DURING the movement, keep your shoulder blades pulled back and down. This will prevent you from going into full shoulder extension and increase shoulder stability.
That means that when your arms are as far away from you as they can be, if your shoulder blades are properly retracted and depressed you will still be able to let your arms go farther away. So, when you are reaching up for the bar, don’t let your shoulder blades float away – keep them back and down. If you find you can still let them go a bit farther (like in the second picture), you know they are not properly retracted. Think of keeping the bottom of your shoulder blades squeezed together throughout the movement. This may cause you to not use as much weight as you would like, but so what? If you use more weight than you can with good form, what are you really accomplishing? THAT’S where you get into more pain and injury.
Coaching cues: keep body “straight”, keep shoulder blades back and down.
Coaching cues: keep shoulder blades back and down, keep neutral arch in back, do NOT round your back when reaching for weight or pulling forward
If your lower back hurts, ask yourself how much you sit. If the answer is “a lot”, you may have found your problem. When you sit, your hips “flex”, this means that the knees come towards the body by means of the hip flexors The hip flexors are pictured here and I know the Alexander Technique teachers will jump all over the psoas, as they should! That’s where I first found out about this very important muscle. You can see how it attaches to your leg AND your low back. When you sit, this muscle flexes, or shortens, which (especially if your abs are too strong – aka, don’t do situps or crunches!!!!) causes you to bend forward, this muscle pulls on your low back. The muscles on your low back (Quadratus Lumborum and spinal erectors, etc.) get stretched, just like the upper back muscles.
Stretch the tight muscles, strengthen the weak muscles. In this case, stretch the hip flexors, strengthen the low back muscles and muscles of the core. The CORE is actually made up of your entire torso and if you want an EXCELLENT book on strengthening the core in the non-traditional way (there is not a single “ab” exercise in this book!) I HIGHLY recommend getting New Rules of Lifting for Abs.
I’m just finishing up this book myself and not only has it improved my posture, it has improved my balance, core strength and overall body strength. I can lift heavier weights than I have in a long time and I have better posterior chain activation as well!
There are WAY too many exercises to list here for strengthening the core and lower back, and in fact, if you want more information on that, I cannot recommend anything here safely, which is why I recommend hiring a personal trainer to help you do these exercises, because done incorrectly you can cause more pain or even injury to yourself.
As for stretching the hip flexors, I have some great ones.
You can do this standing as well. Make sure when you do this stretch, you lean backwards with your torso until you feel a stretch in the front of your hip and SQUEEZE your put on the stretched side. When you stretch the hip flexor, you want to activate the opposing posterior chain muscle, in this case, the glutes.
This exercise is one you can do during rehearsals, while typing, or while lying down. It will stretch your piriformis muscle (the angry little muscle in your butt that gets stretched out when you sit for too long). I recommend doing this lying down: take the chair out of the picture and put the person on his back. Grab the vertical leg and pull it towards the chest. The horizontal leg (the one that is bent across the other) will feel a stretch in that glute and hip.
A good stretch for the psoas is this stretch:
Lie on the edge of a bed, bench or table and pull one leg towards your chest. The other leg should dangle off the edge of the table. DO NOT do this exercise if your doctor has told you not to or you have major back pain. Check with your doctor first if you have concerns. When doing this stretch, you should feel a deep pulling feeling in your abdomen, that is difficult to identify. This is your psoas. Hold for a count of 10-30, depending, and switch sides.
You can also do this on the floor to test for hip tightness. Lie flat on the floor just like in this picture. If your lower back comes off the floor and rounds, it can be a sign of hip flexor tightness.
What are some exercises I need to NOT do?
As you can see in this post, training the posterior chain is of utmost importance. Therefore, training the frontal chain, is not as important. If you have muscular imbalances, you do not want to add any more strength to those muscles. The opposite of the muscles covered in this post would be: chest, quads, biceps.
Exercises I do not recommend if you are in pain:
Chest presses, bench presses, cable flyes (basically any chest pushing exercise), crunches, situps, any kind of oblique twisting ab exercise, leg extension machine.
Other GOOD exercises to include would be exercises that train the entire body:
Make sure you perform these exercises with permission from your doctor and under the supervision of a properly certified personal trainer. If you have any kind of health condition, check with your doctor first.
- Shoulder Pain Secret (fluteangel.wordpress.com)
- Shoulder Pain Part 1 (fluteangel.wordpress.com)
- Identifying Shoulder Pain Part 2 – What To Do About It (innovativeperformanceandpedagogy.wordpress.com)
- Identfying Shoulder Pain Part 2 – What to Do About It (fluteangel.wordpress.com)
- Identifying Shoulder Pain – Part I (innovativeperformanceandpedagogy.wordpress.com)
- De-Mystifying Support and the Diaphragm (innovativeperformanceandpedagogy.wordpress.com)
- Geoffrey Gilbert and the Use of the Body: Taking a Look at “The Gilbert Legacy” for Tips (innovativeperformanceandpedagogy.wordpress.com)
- 3 Exercises + 1 for Core Strength and Stability (innovativeperformanceandpedagogy.wordpress.com)
- What Interests You? (fluteangel.wordpress.com)
Before I continue this post, I would once again like to state that I am not a licensed medical professional and this post is not intended to treat, diagnose or cure any medical injury, disease, cause, condition or ailment. If you suffer from any type of pain you should seek the cousel of a qualified medical professional. A partial list of these professionals is located in the second half of the first post. The information in this blog is given with the intent to educate but not diagnose and I am not liable and do not claim responsibility for any emotional or physical problems that may occur directly or indirectly from the content of this blog.
Now that you know what your own anatomy looks like and how it functions (if you don’t, make sure you read Part 1 first!):
What are some things I can do on my own to address my shoulder pain?
Allowing that you do not have an injury and we are dealing with muscular issues, there are several things you can do. Again, before attempting any type of self-diagnosis or treatment, if you have pain you should seek out the advice of a qualified medical professional.
To even start to begin to correct this, we first have to stretch out the antagonists (chest and front delts) before we can begin to strengthen the posterior chain (rhomboids, etc.). You can see all these stretches in a previous post here: Stretching Adequately Before/During/After Playing
- Doorway or Wall Chest Stretch – will stretch your chest
- Scapular Wall Slides – these will activate your lower traps and rhomboids
- Arm Circles – be gentle on these
- Upper Trap/Levator Scapulae Stretch
With this exercise you can perform it standing and your non-moving arm can be extended straight down with thumb pointing towards the ceiling for a greater stretch
Foam Rolling/Self-Myofascial Release
A foam roller cannot take the place of a massage therapist, but if you cannot afford to go, this is your best option. You can cover a wider area with the foam roller, and get more specific with a tennis ball, hitting your own trigger points. Remember, pain is not necessarily at the point of discomfort, it can be “referred” from another part of the body. When you press on a trigger point, you may feel that pain shoot through the body to where you felt discomfort. Dr. Perry gives more examples of this in his guest blog post Shoulder Pain Secrets.
Guidelines for foam rolling: roll over the muscle to find the most tender spot. Once you find it, lay on it for 20-30 seconds until the muscle begins to relax. Then, roll the entire area. Repeat if necessary.
Tennis Ball Work
This video from Synergy Athletics tells some of the do’s and don’ts of using a tennis ball. Actual usage is towards the end.
This is a really good description of how to use the tennis ball on trigger points in not only the shoulder but the neck. As I have just recently found out from Stop Chasing Pain’s Dr. Perry, if you have shoulder pain, there is a good chance your scalences or SCM (or other deep neck flexors) could be too tight, as well.
In any case, this next description of how to use a tennis ball, I actually found on a message board. I’m sorry that I don’t know to whom I need to give credit for this!
Use the following diagram for an idea of what muscles are being treated.
Image courtesy of http://www.sports-injury-info.com/im…er-muscles.jpg
So here we go.
This is how you treat your (upper) trapezoid muscles.
This is how you treat your rhomboids (down the trapezoids and between the shoulder blades) as well as your infraspinatus. You must squat down to apply pressure. You won’t get enough pressure on the ball if your legs are straight.
This is how you treat your side deltoids (you can do the same with the anterior and posterior deltoids). Put your bodyweight behind it.
This is how you treat the clavicular head of your pectoralis (the upper part of your chest):
Now, this is the tricky part, the side of your neck, the sternocleidomastoid muscle (the one that usually pulls to one side screwing things up.)
For this to work, you need to use the corner of a wall. Furthermore, you need to really drive your bodyweight. This is one of the strongest muscles. Don’t kill it but work on it.
Wanna Free E-Book?
You can’t get much better than this: Mike Robertson put out a free e-book on Self-Myofascial Release using foam rollers, The Stick AND tennis balls. It starts with lower body and the upper body tutorials are towards the end, but if you have a foam roller and a tennis ball, you can really work yourself all over with the help of this book. There is even a section on helping the wrist flexors!
As we have just learned, muscles of the upper back tend to become weak and stretched, due to hours of doing things with our arms in front of us, which leads to tight pectorals
(and Serratus Anterior, I forgot to mention). This means these muscles need to be strengthened and one of the absolute best ways of doing this is resistance training.
Any kind of motion that counter acts the pushing motion (which is what your tight chest muscles are already doing) will help.
These motions are primarily any type of rowing or pulling motion. If you think of these exercises in planes of motion, you have two choices: horizontal pulling and vertical pulling.
Horizontal pulling would be things like seated cable rows, 1-arm dumbbell rows, barbell rows, T-bar rows, X-cable crossovers, Face Pulls, etc.
Vertical pulling motions would be things like Pullups, lat pull downs, althernating pulldowns, chin ups, etc.
All of these exercises will be helpful to strengthening the back muscles. The biggest thing to remember when performing these exercises is to get the form right. What do you need to remember? Retract and depress your shoulder blades and keep them that way THROUGHOUT the movement. This means that when you are doing any kind of pulling motion, when you let your arms extend back, they should not be able to full extend because you still have the bottom of your shoulder blades pinched together. This activates your rhomboids and lower traps and allows them to do their proper job of stabilizing your shoulder girdle.
For these movements you will have to have equipment of some kind, be it a pullup bar, bands or dumbbells, and that is really the only limiting factors of these exercises. I have some great links to the kinds of bands I use on my website at http://fluteangel.net/links.htm if you want to go pick up some. They are very inexpensive and portable and can come in varying strengths.
Prone Lower Trap Raises
These have to be one of my absolute favorite exercises I had never heard of. They look deceptively easy until you try to do them and realize that just lifting your arms without any weight is heavy enough! In fact, this is such a good idea, I might just do a blog post all about activating the lower traps…
Here is a version you can do at home if you don’t have a bench:
Ideally, this exercise is performed face-down with your chest-supported on an elevated flat bench (i.e. longer legs, so that you’re higher off the ground). However, if you don’t have access to such a bench, you can do it bent-over; just make sure that your upper body remains parallel to the floor at all times (no cheating!)
Hold a dumbbell in one hand with a supinated group (the thumb points up at the top of the movement). Begin with the arm dangling below you on the bench. Horizontally adduct (think reverse fly) your arm while maintaining the thumb-up position. At the top, your arm should be at the 9 (left) or 3 (right) positions, and the upper arm and torso should form a 90-degree angle. Throughout the movement, concentrate on retracting the scapulae while keeping it tight to the rib cage (no winging).
Rotator Cuff Exercises
There are an awful lot of these exercises, however, one thing to make sure you realize when performing these exercises is that it’s not about how much weight you can lift. The SITS muscles are small and if they are causing you pain, they may not only be weak, they areprobably tight and stretched which means you need to be even MORE careful. 1-3 lb. dumbbells will be PLENTLY for these exercises.
The two you probably recognize are internal and external rotation exercises. Stand perpendicular to a pole with a band attached. While keeping your elbow tucked in closely to your side rotate your arm inward, pulling the band and then slowly back. Turn the other way and now you are pulling the band across your body.
Soup Can Pours
Gerald Klickstein’s book The Musician’s Way: A Guide to Practice, Performance and Wellness is an excellent book on just those subjects. In Chapters 12 and 13 (and reposted on the blog) he mentions 12 Habits of Healthy Musicians:
The Twelve Habits of Healthy Musicians by Gerald Klickstein
1. Increase playing or singing time gradually
2. Limit repetition
3. Regulate hand- or voice-intensive tasks
4. Manage your workload
5. Warm up and cool down
6. Minimize tension
7. Take breaks
8. Heed warning signs
9. Take charge of anxiety
10. Keep fit and strong
11. Conserve your hearing
12. Care for your voice
- #1: To avert overuse injuries, restrict any increase in your total playing or singing time to a maximum of 10-20% per week (p. 12).
- #4: Respect your physical limits and ask a mentor for advice before you take on an overload of duties (p. 243).
- #5: Pages 37-39 present a six-step process for warming up thoroughly and efficiently.
- #6: Two sections in Chapter 13 – “Balanced Sitting and Standing” & “Meeting Your Instrument” – depict how musicians can form easeful habits. Forty-one photos are included.
- #7: In solo practice, play or sing no more than 25 minutes before pausing for a 5-minute respite. The Musician’s Way itemizes six restorative movements that help to invigorate breaks (p. 75-82).
- #8: Injury symptoms can be subtle, as are the social issues that come into play when unwell musicians who are expected to perform need to rest instead. Pages 237-241 untangle these topics.
- #9: Anxiety doesn’t just scuttle musicians on stage but also impels some to overpractice to the point of injury. Strategies to neutralize anxiety interweave throughout The Musician’s Way and come to the fore in Chapter 7, “Unmasking Performance Anxiety.”
- #10: Music making requires mental, physical, and emotional vigor. Healthy musicians, therefore, mind their nurtrition, rest, exercise, and other self-care needs much like top athletes (p. 245-246).
- #11: Strategies that thwart music-induced hearing loss are summarized in my post “Hear today. Hear tomorrow” and fleshed out on pages 277-291.
- #12: A section titled “Voice Care” encapsulates vocal hygiene under seven headings, the first of which is ‘Drink plenty of water’ (p. 268-277).
As flutists, a good many of us suffer from poor posture, made worse by long hours of playing without being in tune with our bodies. If you are “stuck in your head” and not paying much attention to your body by being so focused on the music, you may notice that when you finally stop playing, you are sore, tight, hurting, and in terrible posture – slouched to the side, front, or otherwise not upright.
Besides understanding your individual body map and taking the time to be aware of your posture WHILE playing, let me propose a postural alteration. Many of you may do this, but many of you may not:
When playing, take note of your arm position. Do your elbows “fly” away from your body? If so, this puts tremendous stress on the little muscles of the rotator cuff, which are not well equipped to deal with this type of endurance activity. Let your arms hang from the flute, keeping the elbows closer to the body and also making sure the left arm is really under the flute. When you sit, make sure you are BALANCED on your sit-bones with your feet FLAT on the floor. This should help keep you in the proper position while leaving your deltoids and biceps to do the hard work of fighting gravity instead of your little rotator cuff muscles.
Dr. Susan Fain has some great information in her dissertation, and I highly recommend you check it out! You can also hear the both of us at the National Flute Association Convention in Charlotte this August speaking with Lea Pearson and Karen Lonsdale about pain prevention.
Additional Resources and Articles
By the way, there is an EXCELLENT 5 – article series called Neanderthal No More: Fixing Your Caveman Posture by Eric Cressey and Mike Robertson over at T-Nation. It can be a bit advanced for some, but if you are looking for a lot of information by people who know what they are doing and you wouldn’t mind a full week’s workout laid out for you, I’d check it out. Not only does it have a full description of anatomy, it delves into body awareness by asking you to check out your own posture in different ways and then testing it to examine your own posture and movement patterns. In part 3 they give client analysis – see if you can determine what’s “wrong” with these guys. :)
Please, tell me if this addresses your shoulder pain and if you found this helpful, leave a comment below. Let us know what pain you are dealing with, what has worked for you and if you have anything to add to the post, let’s hear it! Look for some guest blog posts dealing more with these issues, soon!
And feel free to link your own articles to this blog, down in the comments section!
About the Author
Angela McCuiston is a classically trained flutist with a Masters in Music Performance from FSU. She has studied Body Mapping at Barbara Conable’s “What Every Musician Needs to Know About the Body” workshop, studied Alexander Technique with Janeke Resnick, Alexander Murray and at Appalachian State University and is a Certified Personal Trainer through the National Academy of Sports Medicine. Angela has been involved in weight training since the 1990’s and has been a personal trainer since 2009. You can find out more information about Angela through the “About Me” tab at top or via her websites: http://fluteangel.net and http://www.MusicStrong.com
- Stretching ADEQUATELY Before/During/After Playing (innovativeperformanceandpedagogy.wordpress.com)
- Balanced Shoulders, Open Heart (musiciansway.com/blog/)
- What Interests You? (fluteangel.wordpress.com)
- Great Fitness Deals (fluteangel.wordpress.com)
- Why I Do Not Like YTWL Shoulder Exercises (mikereinold.com)
- Point-Counterpoint: Mike Reinold (robertsontrainingsystems.com)
- Top Priority for Lower Traps (T-nation.com – Mike Robertson)
- Shoulder Pain Part 1 (fluteangel.wordpress.com)
- Ease Sore Muscles With a Tennis Ball (fitsugar.com)
May 23, 2011
One of the most common ailments among musicians, especially flutists, is shoulder pain. I myself suffer from it due to a myriad of reasons. Sometimes it can be helped, sometimes not, but most of the time there is hope for us that we do not have to play in pain. Before we can attempt to fix the problem, we have to correctly identify the source of the pain and just what might be going on. Let’s do a little body mapping. :)
Most of the pain that flutists complain about (and myself personally experience) comes from what we call the left shoulder. If we’re to get specific about it, most of the pain usually originates from the rear of the shoulder in the muscles of the rotator cuff and the rhomboid, specifically.
If you look to the left you will see the muscles that lie on top. If you look to the right, these are the muscles that lie underneath. Look at this picture, can you identify exactly where your pain is?
Where you probably experience pain the most
These lovely little muscles can be the source of a LOT of pain for people. As you can see, the connect the inside of your shoulder blade to your spine, and their job is to cause the blades to retract, or come together. Pinch your shoulder blades together and that’s the rhomboids doing their job.
When your chest muscles are too tight, these guys can get stretched and weak. When this happens, you might get a sharp pain that can travel through your shoulder and even down your arm. You might even have a knot here.
With the exception of the Teres Major, these muscles make up the rotator cuff. I’m sure you’ve heard of it before, but had no idea what it does. It does a lot of things, but for our purposes here what you need to know is how it works so you can play your instrument. The rotator cuff muscles main job is to lift and rotate your arm and keep your shoulder stable within its socket.
For flutists, this is why the left shoulder tends to hurt more than the right shoulder, because we bring our left shoulder up and rotate it in front of us to be able to play. This is the job of the rotator cuff muscles. As you can see, they are very tiny muscles, and holding up an instrument for a long time, especially when their assisting muscles such as the lower traps and rhomboids are already stretched out and weak puts a great strain on them. Compound that with overactive traps and chest muscles and you have a recipe for disaster just waiting to happen.
Actually, this will show you exactly how the shoulder blades. As this video is playing, put your hands on the muscles that are moving and do the movement yourself. Do you see how your own body works?
The Antagonists: The ones partially causing the pain!
These muscles may be less thought-of as contributing to the problem of shoulder pain but may in fact be the main cause. Most Americans now spend a large part of their day in front of their computers, sitting and driving. What do all these have in common? The arms are in front of the body. What main muscles bring the arms forward? The pectorals. Of course we have assistance muscles such as the front deltoids, so do this with me:
- Put one hand on your chest, near your shoulder.
- Bring your other arm in front of your body and feel which muscles move
You probably notice that the front of your shoulder tightens and so do your chest muscles near the shoulder joint.
Now, exaggerate that motion.
- Put both arms in front of you like you are typing
- Squeeze your arms in towards your body
- hunch your shoulders and slouch your upper body
Does this resemble how you might look after spending too long at the computer, or driving? If you hold this exaggerated position for long, things will start to hurt. You’ll notice pulling in your rear delts, and your chest will get sore.
What’s going on here is a chronic muslce imbalance between the front of our bodies and the back of our bodies, called the frontal plane (or frontal chain and posterior chain). What happens is that the muscles bringing the arms forward cause the muscles in your rear shoulders/back to get stretched. Over time, these rear muscles become weakened due to being in a stretched position for so long and not being contracted. The frontal chain muscles of the chest/front delt get tight because they are contracted for TOO long.
See how this works?
The “Shrug” Muscles: Trapezius and Levator Scapulae
As you watch these videos, can you see the motions you use to play your instrument, drive, type, eat, fold laundry, etc. and how doing so much of one movement, and not enough of the opposite can cause you pain?
The jobs of the traps and levator scapulae are to shrug the shoulders upward and the job of the lower traps is to bring the shoulder blades downward. The traps are actually divided into 3 sections of fibers: upper, middle and lower. Most people have overactive and/or overdeveloped upper traps. Please don’t do shrugs, there’s no need. What you NEED to do are get your lower traps firing, because not only are most people not aware that they are there and have a separate job to do, most people’s lower traps do NOT do their job, which is to bring the shoulder blades downward.
- Roll your shoulder blades backwards
- Right before they roll forward again, squeeze the bottom of your shoulders together
- if your shoulders come up towards your ears, you’re doing it incorrectly.
- Done correctly, you are performing shoulder blade depression and retraction and activating the lower trap fibers and rhomboids.
- Your chest should stick out and there should be space between your shoulders in front.
Does that feel weird? If so, good! You’re probably doing it right! This position is the first position of good form for all weightlifting exercises. I’ll cover that in another post, but knowing about it now can save you a world of hurt, just by understanding how these muscles are designed to function.
Now that we know where and why, how do I stop the pain?
There are a couple of things to note. You have to know is your pain a muscle pain or an actual injury? If this is something that has been bothering you for awhile, I highly recommend going to see a doctor of some sort first before self-diagnosing.
Who to see
You have a lot of choices, I’m going to name a few for you from which to pick:
This type of doctor can, of course, tell you if anything else is wrong with you. Your source of pain could not be what you think it is and it could actually be a nutritional deficiency or other abnormality. This doctor can also tell you if what you have is an actual injury. If you have an injury, you may or may not want to take medicines prescribed to you by this type of doctor (such as muscle relaxers) and you may also get prescriptions for further testing such as an MRI or a script for therapy from a Physical Therapist.
These people will treat your injury by strengthening the surrounding muscles and rehabbing the injury itself. (PT’s out there, feel free to chime in here on what else you do!) They may treat you with various modalities including stretching, light weights, heat, ice, massage or electrical stimulation. If you have a real injury, this may help.
Massage Therapist/Active Release Technique Therapist
These two are NOT the same, do not get them confused. A massage therapist also does more than “feel good massage” or Swedish Massage. Most of the massages I have had in my lifetime were anything but “feel good”! A massage therapist may provide techniques such as deep tissue massage and trigger point therapy. They can manipulate the fascia around muscles if it has become stuck, trigger point will release knotted muscles and besides freeing up an injured area of knots, massage will also increase blood flow to the area and increase lymph flow, which takes away waste materials from the muscle. Trigger points are sometimes thought to be areas of waste materials that have gotten blocked.
ART is different in that you may remain fully clothed and there is a lot more movement. The practitioner will stretch you and press on different areas while moving your muscles and/or limbs to break down scar tissue. It is particularly helpful in treating overuse injuries. You can find out more information at http://www.activerelease.com
Now, if you have an injury, you must get that rehabbed first, or get a doctor’s note to provide to your personal trainer letting them know exactly what is wrong and what you can and cannot do. If you are not injured, you may be suffering from either Overuse Syndrome or Muscular Imbalances, either of which can be helped by a personal trainer.
A good trainer will not only educate you in stretches that will help you release the antagonists that may be causing your problems, they will also show you corrective resistance training exercises that will strengthen your weak muscles. When your rhomboids and rotator cuff muscles (among others) are stronger, not only will you be able to play for a longer time without pain, you can become and stay injury-free! Add to this the benefits of better body awareness and you have a body that is better prepared to deal with the demands of being an instrumentalist.
As a shameless plug – I have availabilities for in-person and online training so you can get one-on-one training programs designed specifically for you.
See the next post: Shoulder Pain Part 2 for stretches and exercises you can do on your own to alleviate shoulder pain.
(This post was just getting too long! :)
This post is made with the knowledge that I am not a medical practitioner of any sort, and therefore cannot prescribe anything.