Additional Disclaimer - 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
1.Doorway or Wall Chest Stretch - will stretch your chest
2.Scapular Wall Slides - these will activate your lower traps and rhomboids
3.Arm Circles - be gentle on these
4.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. [youtube=http://www.youtube.com/v/zzkIPKlvmFQ]
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. [youtube=http://www.youtube.com/watch?v=icP1SKXIuaw]
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)
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! Download the book in pdf format here
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.
(Image via Wikipedia)
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 Pull ups, lat pull downs, alternating pull downs, chin ups, etc.
All of these exercises will be helpful in strengthening the back muscles, shoulder muscles and muscles of the rotator cuff. The biggest thing to remember when performing the exercises that warrant movement of the shoulder blade is when and how to move it. In movements that have you trying to maintain an upright posture and keeping the spine from moving, these are times when you want to depress and retract the shoulder blades (bring them back and down) and keep them there throughout the movement. This will activate our mostly weak, over-stretched and under-activated rhomboids and lower traps and taking the compensation away from other muscles. Exercises that would use this example would be ones such as prone lower trap raises, soup can pours and rotator cuff exercises. In other instances where the arms are pulling to or pushing away from the body, with these movements you want to make sure the shoulder blades move properly through their full range of motion. For example, when doing a lat pull down or any type of row, while maintaining an upright posture, keeping the spine in neutral, as the arms come away from the body the shoulder blades should be able to move apart, closer to the sides of the body, and when bringing the arms back closer to the body, initiate the movement by squeezing the bottom of the shoulder blades together, and then bringing the arms to the body. This fully activates the rhomboids, lower traps, etc..
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: From Neanderthal No More By Eric Cressey and Mike Robertson
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 are probably tight and stretched which means you need to be even MORE careful. 1-3 lb. dumbbells will be PLENTY 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
In a standing position, start with your right arm halfway between the front and side of your body, thumb down. (You may need to raise your left arm for balance.) Raise your right arm until almost level (about a 45° angle). (Hint: This is like emptying a can.) Don't lift beyond the point of pain. Slowly lower your arm. Repeat the exercise until your arm is tired. Then do the exercise with your left arm.
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
The Musician’s Way specifies ways in which you can incorporate these twelve habits into your lifestyle. Here are a few highlights:
•#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! The both of us were recently at the National Flute Association Convention in Charlotte this past 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. :)
Also check out: