You may be thinking, "Wait, self-treat my back pain... isn't that your job?" As a physical therapist I often work with people that have low back pain. It shouldn't be any surprise, as it affects around two thirds or more of residents of the United States. The fact of the matter is, our current health care system does not empower people with the knowledge that they need to take action at the first onset of low back pain. Most people don't even know who to see first. If I may get on a very small soapbox for just a moment... very small... physical therapy should always be the first choice of practitioner in treating low back pain. Yes, even before your primary care physician, even before you get an X-ray or an MRI, and even before Chiropractic. Direct access laws allow this and that is their purpose; to avoid needing a referral first. But even BEFORE physical therapy, you should have the tools needed to at least do something for yourself when it first happens. My job is not done if you are not empowered with the knowledge to help yourself. For the next 11 weeks I will be writing a post just like this one sharing some of that knowledge with you about the steps that YOU can take to self-treat low back pain. That is the intent of this series. To skip the steps below and watch the video, please click here.
Injury prevention is something that is discussed often in the physical therapy world. Many physical therapists that work with athletes focus on this area, whether its running, or soccer, or golf, etc. Perhaps more uncommon is the idea of injury that can take place for musicians, specifically when playing a keyboard instrument such as the piano or organ. One might wonder how an injury might occur just sitting on a bench playing the piano, but in reality there are multiple ways that injury can occur while playing the piano or organ. Recently a close friend of the family who is a music teacher and who offers piano lessons brought this topic up and wrote her own blog post about this very topic. I will be the first to admit that I had never considered this in the past. Please be sure to read her post here, as I was featured as a guest on her blog. She asked some great questions about this topic and I was able to give some expert advice. In my post I would first like to highlight some of the possible injuries that can occur, as well as to provide a list of ten exercises that one could do for prevention. These would serve as a warm up prior to sitting at the bench in order to prevent injury through proper posture and adequate flexibility.
So, what injuries are possible while playing a keyboard instrument? First, the wrist/hand and forearms are a potential source of problems due to development of carpal tunnel syndrome (CTS), ligament sprains at the wrist/digits, and even neural tension at the wrist, elbow, or shoulder (or all three) due to poor posture. Posture is a crucial aspect of injury prevention. Ideally, one should be sitting upright with feet flat on the floor (unless using pedal with right foot or playing pedals on an organ), shoulders back, and head erect with eyes relaxed looking at the keys/sheet music. The hands and wrist should be relaxed, as if sitting on top of a bubble. If this is NOT done and the individual is slouched, multiple impairments can result. Namely: shortened and tight neck muscles (can result in tension headache and compression of cervical nerve roots), increased strain of upper back and shoulder muscles (results in poor shoulder stability and lack of support for the neck), increased stress on the discs and facet joints of the lumbar spine (ligament strain of the joints of the back and possible disc bulge or rupture), shortened and tight hip flexor muscles (also results in more stress on lumbar spinal segments), etc, etc. The take away here is that posture is HUGE for preventing injuries at the piano/organ.
What can be done about this, besides maintaining adequate posture? The exercises I am about to recommend will go a long way to facilitate good posture while playing, flexibility of the neck, upper limbs, and trunk, as well as to promote warming up the tissues prior to playing. Let's face it, playing a musical instrument can by physically challenging and can certainly be a form of exercising. For piano, the hands must be limber and agile to play each key and to reach octaves, etc. And if the song is a fast tempo and has a large range of notes, the entire upper limb system is getting a workout. My hands and arms are always fatigued after a long session at the piano. This is expected and perfectly natural. So, as before any workout, a warm up is essential. And no, I don't mean sitting at the piano and cracking your knuckles and your neck. Leave that for the cartoons. The last part of this post will be to highlight the exercises that will provide a well rounded warm up for injury prevention. There is a video linked to this post to see the exercises in action and then a written list below the video.
Recommended Exercise Routine
The following exercises are found in the video that you just saw above. If you are looking for an exercise ball and yoga mat like used in the video you can get them via the links in this post. * For the following exercises, I recommend 5-10 repetitions of each immediately prior to sitting down on the piano bench. *As an Amazon Associate I earn from qualifying purchases
1. Standing pectoralis doorway stretch - This will help to open up the chest, stretch the pectoralis muscles, and to encourage erect posture.
2. Standing pectoralis/biceps stretch - Again, this encourages opening up the chest and bringing the shoulders and arms back. Tightness in pectoralis major and minor can result in neural tension of the brachial plexus (this is the bundle of nerves that exit the neck, under the collar bone, and into the shoulder and arm).
3. Standing upper limb prayer stretch/neural glide - This exercise moves the entire upper limb through a range of motion that encourages lengthening the nerves of the upper body through all of the bends in the limb. This is not as specific, but is a great warm up exercise.
4. Median nerve glide - This is a specific stretch for the median nerve of the upper limb. This is the culprit in carpal tunnel syndrome as the median nerve is often compressed at the wrist.
5. Radial nerve glide - Another specific stretch for the radial nerve. This supplies the sensation for the back of your hands and is the motor nerve for the muscles that extend the fingers and wrist.
6. Ulnar nerve glide - A specific stretch for the ulnar nerve. This supplies the sensation for the half of the palm near the ring and pinky fingers. This nerve can be compressed at the elbow (where your funny bone is) as well as at the wrist (Guyon's tunnel). Guitarists may need to worry about this one more than the medial nerve, but both are important to stretch for the keyboardist.
7. Cervical/neck rotation, side bending, and flexion/extension - These are combined due to the fact that they are all the same area of the spine. These are great for general flexibility for the joints of the neck while turning the head right and left, bending to the side, and looking up/down. This is important for limbering up the joints of the neck as well as warming up the muscles that will be working to hold your head up while playing.
8. Standing trunk rotation - General flexibility exercise for the upper and lower back to loosen up the joints of the spine and warm up the muscles of the trunk
9. Back extension - General flexibility exercise for the lumbar spine to encourage good sitting posture and to move the spine in the opposite direction of slouching. This can alleviate soreness in the back as well.
10. Lower trunk rotation with legs on ball - Good general flexibility exercise for the lower back muscles and joints. This can be a great one for relieving stiffness and soreness in the lower back as well. If you are looking for an exercise ball you can purchase one here.*
*As an Amazon Associate I earn from qualifying purchases
In this case, I mean in the LITERAL sense!
So, here's the thing, there are a TON of exercises that you can do with an exercise ball.* If you have worked with me as a client before, or if you plan to in the future, there are so many ways you can prescribe exercise, even a home exercise program, with a ball* such as this. Why? Well, they are light weight, relatively easy to store, and you can do so many exercises without even using weights and you will really get a workout! I thought I would put together a list of exercises that would be really useful if you obtain a therapy ball. Any of the links found in this post will take you to a ball that I recommend in particular*. The GoFit professional stability ball is the one that I use in the clinic and in my videos, because its not expensive and it even comes with printed exercises on the side to give you an extra challenge and ideas of what to do. WARNING, I would NOT start with the ones printed on the side of this particular ball. But I am going to give you even MORE ideas so you can get started now! ( Wave your mouse over images for caption). These particular exercises would be helpful for back pain. *As an Amazon Associate I earn from qualifying purchases
So here goes:
Prone Glut Sets Bridges on ball
Lower abdominal sets Ball crunches
I hope you find these exercises helpful and that this gives you an idea of how you might manage back pain by obtaining a therapy ball. This one tool could save you lots of time and money due to space savings and versatility. For more information, please call me today to discuss other ideas for treating your back pain. 918-251-7199.
P.S. If you are looking for a soft spot to lay this yoga mat is the one I use and I love it because of its extra cushioning! Be empowered!
*As an Amazon Associate I earn from qualifying purchases
Low back pain is common…VERY common. According to an article published by the American Physical Therapy Association in November of 2017, low back pain (LBP) affects nearly two-thirds of Americans! There is a great need for education on prevention of LBP as well as what to do once you begin to experience it yourself.
The cost of LBP to the United States healthcare system is enormous, and much of this cost is related to surgical intervention. Though surgery is by far the most expensive intervention for LBP, orders for musculoskeletal imaging, such as MRI, CT, and X-rays, are also quite costly. This is important because forward-thinking healthcare should be working towards reducing unnecessary costs to the consumer. The fact of the matter is that non-specific LBP does not need to be "diagnosed" through imaging in order to be treated by a physical therapist. If you were to do X-rays and MRIs of the spines of the majority of Americans, even those in their 20s, you would find impairments. However, many of those same Americans would also have never experienced LBP.
Every part of the human body ages, including the joints and the intervertebral disks of the back. Through the natural aging process those disks lose water content resulting in the gradual loss of space between the vertebrae. Furthermore, joints endure natural wear and tear over time that may result in arthritis due to inflammation of the cartilage. These impairments do not always cause pain and should not be the sole reason that clients are referred out for surgery or even for physical therapy.
I have treated many clients with non-specific LBP, without ever having seen a scan or X-ray, and have successfully resolved or drastically improved their symptoms allowing them to return to leisure activities and family life. In one particular case, my evaluation concluded that adhesions in the connective tissue (tendons, ligaments, etc.) were the cause of the discomfort in addition to restrictions in range of motion. In other words, the cause of LBP was not spinal. However,you can easily imagine that imaging prior to physical therapy might have resulted in a misdiagnosis of "degenerative joint disease" or "degenerative disk disease" for this client, which could then have led to unnecessary, invasive, and possibly unsuccessful treatments such as injections or surgery.
As a Doctor of Physical Therapy I am highly trained in differential diagnosis. Therefore, I am able to distinguish between a condition that I have the knowledge and skills to treat and one that merits immediate medical attention. In another case that I will never forget, I evaluated a client, who was referred to me directly by her primary care physician. An MRI was performed prior to her referral, but the results had not yet been reviewed by the physician by the time she arrived for her physical therapy evaluation. By asking probing questions, carefully listening to her description of symptoms, and examining her physically, I was able to determine that something was seriously wrong and that she needed immediate medical help, not physical therapy.
A motor vehicle accident that caused severe flexion of her spine was the instigator of her symptoms. She arrived at my clinic in severe pain and was visibly in tears as I was evaluating her. She described pain that radiated to both rib cages, buttocks, and legs. This report was an immediatered flag and prompted me to ask whether she had experienced any changes in bowel or bladder function. With a look of great surprise, she replied that she had indeed been unable to hold her urine or feces since the accident. This is a serious sign of damage to the central nervous system and a potential medical emergency. I immediately stopped my evaluation and called her physician to report that I suspected a mid-thoracic level posterior-central disk herniation. I informed my client that physical therapy was not recommended and reassured her that I was in communication with her physician. A half hour after our initial conversation, her physician called me again because he had just received the MRI results and was shocked at what he saw – a posterior-central disk herniation pressing into the spinal cord – a very dangerous medical situation. He thanked me profusely for communicating with him and stated that he had already placed a call to a neurosurgeon for immediate follow-up for the client. Although it was not the best news, my client was able to get the care that she needed based on my prompt communication with her physician.
The main point of this article is not to say that imaging in the presence of LBP is never necessary, but rather that it is over-utilized in our health care system. I highly recommend that if you or a loved one have LBP, you seek the advice of a physical therapist as a first course of action. In most states, a physician referral is not required for you to seek out the help of a physical therapist immediately. The same APTA article mentioned above stated that 37% or fewer of people that experience LBP actually seek professional treatment. Don't be one of those people. Take action and be empowered!
Dr. Michael Hyland, DPT, CEEAA has been a physical therapist since 2012. He is a Certified Exercise Expert for the Aging Adult and an expert in Parkinson's Disease. He owns Hyland Physical Therapy and Wellness in Broken Arrow, OK