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“Static Loading, Back and Disc Problems: Winner of the Independent Book Publishers Gold Medal”

0 Janet Horvath
horvath_cover Editor's Abstract

Janet Horvath has revised her book, Playing (less) Hurt: An Injury Prevention Guide for Musicians, and the new edition is now available. Janet has updated the book and added 100 pages to include new information for educators and training, information for jazzers and rock musicians, new ergonomic products, an extensive hearing chapter, new photos and much more. Polyphonic is pleased to excerpt a section on static loading and the fatigue that muscles endure (and the damage that can be done) with prolonged periods of static positions.

I wish every conductor out there would read the first few paragraphs of this excerpt and adjust their rehearsal schedules accordingly! Janet provides invaluable tips for alleviating some of the pains associated with playing prolonged soft and slow passages, as well other posture issues.

Janet’s book received the Gold Medal in the 2009 Independent Book Publisher National Awards in the health category. Congratulations, Janet! For more information, click here.

Janet has graciously offered a 15% discount to registered Polyphonic readers. Ordering details are at the end of this article.

Ann Drinan

horvath_award

Janet receiving her Independent Book Publishers Gold Medal in June, 2009

Muscles like to be in neutral position or at the midpoint of their normal range of movement. Loading, or putting stress on joints in uneven or asymmetrical ways due to awkward, fixed or stiff body positions will result in static loading on the body. Static postures are enemies to be avoided. One can describe muscular activities in two categories: dynamic (or rhythmic) and static (or postural).

According to Etienne Grandjean in his book Fitting the Task to the Man, a Textbook of Occupational Ergonomics, we can do a dynamic movement for a long time without fatigue. This is because during a dynamic movement we alternate between tension and relaxation or flexion and extension. Blood flows generously, even up to ten to twenty times more than the flow at rest, and waste products are flushed out. By contrast, static postures and positions (such as holding up an outstretched arm) tire us out, and damage can result if we hold these static positions over long periods of time. This is due to the fact that in a static position our muscle is compressed and is in contraction, where blood does not readily flow through the muscle. Oxygen is not replenished and waste is not removed. We cannot continue a static muscular effort long, before fatigue, and eventually pain, set in.

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The very cool cover to Janet's new edition of Playing (less) Hurt

Static effort is much more strenuous. Therefore, when evaluating a movement, the static component is most important. Unfortunately, only when we are lying down is static loading avoided. Static loading occurs every day as a by-product of living, as it is often postural. Static loading occurs in almost all forms of work.

If static effort is repeated daily, damage to tendons, ligaments and discs may occur. “Muscles subject to static work need 12 times longer to recover from fatigue. Moreover, the muscles of the upper extremity cannot maintain a contraction level in excess of 20 percent of their strength for more than a few seconds without significant fatigue. Hence in the absence of sufficient recovery time, prolonged and excessive static work will weaken joints, ligaments and tendons,” says Vern Putz-Anderson in the book Cumulative Trauma Disorders: A Manual for Musculoskeletal Diseases of the Upper Limbs.

When you’ve been in a prolonged static position and your muscles are called upon suddenly to do a dynamic movement you need a blood surge, which is sometimes unavailable because your muscles are constricted. Injury may occur. This is why it’s much harder to play slowly and softly, and it is more fatiguing to go from long held notes to pyrotechnics!

We had palpable proof of this recently in the Minnesota Orchestra. One week our program billed the very demanding Dvořák Carnival Overture, the Bartók Rhapsodies for solo violin and orchestra and the mammoth Eleventh Symphony of Shostakovich. The following week consisted of Mozart’s Exsultate Jubilate, Haydn’s Cello Concerto in C and Mozart’s Requiem. Which was the more taxing program? The second seemed as though it would be a welcome relief, but it was by far the more physically taxing! Our arms were fatigued to the point of “falling off,” because these works featured many long notes, soft dynamics and overall holding back. In music like this, try to find ways to keep moving. Focus on deep breathing and on releasing tension. Do anything possible to avoid the static load scenario.

A bent head is an example of static load. When your head is bent forward or backward or to either side, your neck muscles are engaged in a lifting task. Your head weighs about fifteen pounds. Supporting your head constricts the muscles in your neck and shoulder area, obstructing blood flow. The stress is exacerbated if your arms are extended in front of you or if your torso is bent forward. Tight neck and shoulder muscles can con­strict blood flow and compress surrounding nerves, many of which extend down the arm. Over time, this tension can bring on disc or nerve problems, headaches and eye strain.

We who hold instruments in awkward positions on a daily basis must be especially vigilant. It is essential to be mindful about posture at all times. A common trouble position is forward flexion—when you lean too far forward while sitting or standing. This requires sustained muscle tension and static loading in your back muscles. The forward shoulder position also destabilizes the arm during movement, making its motion more difficult. The unnatural arrangement of the spine stresses ligaments and muscles in and around the spine area. Legions of cellists, flutists, guitarists, bass players, bassoonists and many others are guilty of hunching forward over instruments and thrusting their heads forward or down.

It is important to counter forward shoulder and hunching upper back positions by doing motions opposite to the ones we do constantly at our instruments. Try the foam roller stretch, which stretches the pectoral muscles and shoulders. (The foam roller stretch is described in Janet’s book. – Ed.)

It is very important for cellists to maintain proper end-pin height and to avoid hunching over cellos or thrusting heads down and forward. The neck of your cello should be above your left shoulder, not on it, and the neck of your cello should be away from your face. Sometimes cellists become very uncomfortable and tight in their neck when the C-peg snuggles into the base of the head at the neck. It is important to angle your cello slightly across your body so this does not happen and your neck and head can feel free. The C-string peg should be under and behind your left ear and not touching your head, allowing some clearance. Your cello can also be tilted toward the A-string side of the instrument or the C-string side depending on what you are playing at the time. Gently rotate the instrument with your knees and maintain constant fluidity rather than squeezing with your knees. If discomfort still occurs, String Vision carries ergonomic key pegs or “posture pegs.” These replace the C and G peg heads so that they are flush with the scroll. Tuning is done using a removable key and no alteration to the scroll is necessary.

Tingling and numbness in the ring and pinky fingers, pain across the back of the shoulders as well as headaches can be caused by extending the neck forward for too long. This is exacerbated when arms are extended forward and/or the torso is bent forward or shoulders are raised. Where numbness is concerned, always consult a physician to rule out a nerve entrapment such as carpal tunnel syndrome or ulnar nerve compression.

Violinists, violists, flutists, bassoonists and others who tilt or rotate their head can create muscle imbalances over time. The muscles on one side become shorter and stron­ger than those on the other. This can lead eventually to joint dysfunction and possibly nerve compression.

Limber your neck by warming-up. Take breaks. Reduce “holding” tension. Violin­ists and violists, refit chin and shoulder rests. Be careful about your head and neck angle. Sometimes we may be susceptible to neck tension despite our best efforts. To release try nodding, looking side to side, tilting your head (left ear to left shoulder, etc.), shrugging your shoulders, doing shoulder circles often, and rotating and shaking your head periodically. Be vigilant about posture at all times, even away from your instrument.

A Few Suggestions for Good Posture

Sometimes musicians are so accustomed to their playing positions that they are the last ones to know their torsos are angled, twisted or tense. Use a mirror. Ask a colleague to assess your posture or videotape yourself.

Don’t stop there. Place your upper back against a wall and bend knees as if you are sitting. Mime playing your instrument. You may discover that this position does not correspond to your accustomed playing stance.

Good posture should be balanced and relaxed. You should not have to strain to maintain it. Keep your shoulders down and not pulled upward, backward or forward. Keep your lower back in a natural curve (lordosis): neither exaggerated nor flat. Many body awareness experts use imagery to help with correcting posture. Yoga teachers ad­vocate “making space” in your torso. By raising your rib cage and filling your lungs with air (or pretending it’s helium), you allow your internal organs the space they need. Think about draping your shoulders over a raised rib cage and elongating the length of your spine, especially at the back of your neck. Alexander Technique specialists suggest you think of yourself as a “puppet on a string” held from the top of your head, with your arms and shoulders hanging down. For others it helps to “think tall” to counter the effects of gravity pulling us down.

When sitting, avoid twisting or leaning to either side, backward or forward. Your center of gravity should be forward and your body weight should be on your sitting bones and your feet. Do not play with your legs crossed at the knee or ankle or while curling legs around chair legs. To test your sitting posture, put your instrument aside and sit with your feet flat on the floor. Now try to get up. Your weight, if balanced far enough forward, will allow you to get up without any major re-shuffling in your position. Bring the instrument to you rather than compromising your posture to reach for your instrument.

Musicians who are able to practice while standing should alternate between sitting and standing. Make sure while standing that you are maintaining a natural curve or lordosis, by keeping your knees slightly bent instead of locked or hyperextended (actually bent slightly backwards). Your body should feel fluid. This is equally important for conductors, who may bend forward at the waist or lock knees and arch too far back. While sitting, shift leg position frequently. Cellists, one foot slightly in front of the other seems to work well.

Be vigilant about your music stand placement. If you are alone on your stand, place it directly in front of you at a height that allows you to keep your head level. If you share a music stand, move your chair and body so that you do not have to turn your head or twist your torso to see your music. Align it in such a way that you can see the music and the conductor without any up and down movements of your head. Pianists also should be vigilant about the height of their music racks. Keyboard players need to try to adjust their music racks in such a way that their heads and necks can maintain as neutral a position as possible.

Disc Problems

Static loading can proceed from your muscles to the discs in your spine. Careful avoidance of twisting or turning your back, twisting or tilting your neck, or thrusting your head or chin can literally save your spine. In their book The Athletic Musician, physical therapist Barbara Paull and violinist Christine Harrison explain how damage may occur:

When we bend our necks to look down, or bend down, or bend over, the front of the spinal bones move closer together to curve the neck or back forward. The discs between the bones are squeezed at the front and they behave just like jelly donuts. The jelly-like center oozes through the disc, away from the squeeze and pushes against the strong, outer disc wall at the opposite side causing a bulge at the back of each disc. When the squeeze is removed the bulge slowly subsides and the jelly returns to the center. There is room for small normal disc bulges. Whenever musicians hold their heads tilted to one side for a period of time, their neck discs will bulge on the opposite side… What goes wrong? The fault lies in our lifestyle and unnatural stresses we place on our spine and discs, causing the outer fibrous rings of some discs to crack and fissure too soon in life. The first cracks in the outer fibrous layers can occur quite early in life if the spine is subjected to direct trauma or very physical work, including bending to lift weights, or if the spine is held in an awkward position for long periods of time. These cracks occur in the part of the disc that is bulged most often or most vigorously.

Sustained or frequently repeated twisting movements serve to hasten the formation of cracks in the fibrous outer layer of the discs involved, probably by weakening and separating the angled fibers. The squeezing that occurs during spinal bending movements and maintained bending positions, causes the discs to bulge much further than they should. The space behind the disc is not sufficient to accommodate this larger bulge and it comes in contact with the spinal cord nerves. If you apply pressure to the spinal nerves they produce pain.

All of this is to say that we as musicians must be extremely careful about our whole spine, starting with our necks. During playing, dangerous positions include poking the head forward, bending the neck forward or sideways, or twisting it for any length of time. The neck needs to be kept in neutral. This is especially challenging for violinists, flutists and bassoonists, who must take extra care to release the neck after any awkward positions.

Since we spend so much of our working life in postures that may give rise to wear and tear over time, avoidance of forward bending is advisable while lifting heavy objects. Many of us have been told to be careful when lifting, but how many of us really are cautious with those many daily forward-bending activities? You can protect your back by tightening your abdominal muscles and bending your knees while lifting and trying to keep your back erect. Be wary of turning, twisting or reaching to lift your instrument cases.

Aggressive forward bending when exercising can be risky too, especially for those whose hamstrings are tight and whose lower backs are already weak or injured. Aggressive forward bends, stretching and certain exercises can aggravate and exacerbate back pain. Disc damage can be caused by repetitious forward-bending movements even when they are small. Budget permitting, seek a physical therapist, licensed personal trainer or certified yoga teacher to guide you.

When you’re under stress or nervous, be aware that lifting your shoulders is a natural tendency. Muscle tension from stress manifests itself in the trapezius muscles, located in the upper back and shoulders. To avoid static loading in this area, keep your shoulders down, in a neutral position and remember to breathe slowly and deeply. Whenever you feel yourself tightening up, try one big shoulder roll by squeezing your shoulder blades together with shoulders down, then lift them high up towards your ears, then roll them forward and down. This can go a long way to releasing tension in this area.

Try to avoid the urge to freeze. As a conductor holds out a final chord you can slowly and gracefully lower your arms without being obtrusive. Keep tension from building up by taking every opportunity during performance to move, to wiggle, to shrug or to pull arms back and to stretch the neck. Fidgeting, moving and stretching is important. Emil Pascarelli suggests the following: “Any posture that is rigidly held for a long time is exhausting, even if you are in perfect alignment. Move around while you work: make tiny adjustments that keep the position dynamic instead of static.” This goes for legs and feet as well. We are trained to sit in an orchestra virtually like statues! Have you heard of the risk for deep vein thrombosis or blood clots during extended airplane, car, or bus trips? This goes for long days and weeks of sitting for rehearsals and concerts, too.

Another “move” I find helpful to release those tight neck and shoulder muscles is to bring your chin down and in, making a double chin. Press your upper torso (your head, neck, shoulders and trapezius) firmly into the floor, the bed (when lying down) or into the car headrest (when driving and you are stopped at a red light). Hold. Release. This should alleviate some tension in that area.

Take breaks. Even after arduous exercise the metabolic recovery in muscles is ten to fifteen minutes. Research shows that there is an 80 percent recovery in your muscles even after one minute of rest when a muscle is not over-fatigued. How often do you dangle your arms during practice?

Remember, even minor static loading can produce fatigue, which eventually can lead to pain in muscles, as well as longer-lasting damage to joints, tendons and ligaments. Static loading is therefore associated with higher risk for arthritis, muscle spasms and inflammation. The 10 ONSTAGE STRETCHES found in my book can alleviate some of the stiffness associated with static loading. In a nutshell, keep tabs on these risky postures:

Risky Postures

  • IN NECKS: tilting, rotating, or cocking heads forward or down.
  • IN TORSOS: bending, twisting, or leaning forward or backward.
  • IN WRISTS: deviating, lifting, or dropping wrists or hands.
  • IN SHOULDERS: lifting, twisting, or rolling shoulders forward.
  • IN THUMBS: squeezing, gripping, pinching, or angling thumbs.
  • IN LEGS AND FEET: sitting immobile or standing still for extended periods of time.

Moves for Extended Sitting

Don’t let extended sitting and/or cramped conditions put you at risk for a deep vein thrombosis. DVT is a blood clot most commonly in the calf. Signs include: pain in the leg, usually worse when standing and sitting, swelling in the leg most often in the calf, and redness or warmth in the area. Keep moving. Some of these may be subtly done even onstage.

  • Get up and move around at least every 2–3 hours during practicing as well as rehearsal and performance.
  • Do calf exercises at least once every hour:
  • 1. Pull toes up and then relax.
  • 2. Press the balls of your foot down and raise the heel.
  • 3. Do ankle circles.
  • 4. Reposition your legs and feet often.
  • 5. Drink plenty of fluids.
  • 6. When you have the opportunity elevate your feet.

Newly rewritten & updated 2009 Edition

Self-published by Janet Horvath: www.playinglesshurt.com

Ordering information is available here.

Registered Polyphonic readers can obtain a 15% discount by writing the following promotional code on the order form and mailing or faxing it to the address or fax number on the form. Orders are also accepted by telephone at (612) 870-4200.

The PROMOTION CODE for your discount is: POLY25PROMO.

Note: You must download the order form in order to receive the Polyphonic discount. You cannot obtain the discount through an online purchase.

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