Author: Sarah

Low Back Pain

Overuse Injury:

A primary cause of lower back pain for musicians is overworking muscle in the backs, which leads to soreness, muscle spasms and trigger points.
Muscle spasms are involuntary muscle contraction that may start out as twitching but often lead to larger painful ‘knot’ in the muscle.
Trigger points are smaller ‘knots’ in our muscles that cause pain to refer or travel
As these muscles are continually overused without letting the bodies rest; the pain often turns into stiffness, increased muscle fatigue and continuation of muscle and joint pain as these muscles continue to spasm and pull at the vertebra they attach to.

Bulging disc:

Between the bony vertebra of the spine are cushion like discs made up of cartilage. The outsides of these discs are ringed layers of hard cartilage, [annulus fibrosus while the inside is a gelatinous cartilage material that allows the discs to be more flexible [nucleus pulposus].
When large shear and/or twisting forces are applied to the spine, the outside layers of the disc can tear which can cause low back pain. Two examples of how this can occur are: repetitive lifting heavy instruments or cases while twisting or bending from the spine, or from years of sitting and/or standing and moving with poor posture while playing an instrument.
Sometimes when a disc is torn and these damaging forces continue to be applied to our spines, the center gelatinous portion of the discs can protrude through the tear in the outer rings. This is called a disc herniation. Disc herniation's often puts pressure on surrounding nerves that are exiting the spine to supply the muscles in your lower back, buttock and legs which causes pain in these areas.

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Hyper– and hypo- lordosis:

The spine naturally curves at the lower back, upper back and neck. These curves work as shock absorbers to distribute the stress applied to the spine when sitting, standing, walking, running, etc.
When the curve in the low back is greater or less than normal the shock absorbing properties of the spine do not work as effectively resulting to excess stress applied to the surrounding muscles, tendons and ligaments leading to low back pain.
Often musicians will either straighten or exaggerate the curve in the low back while trying to sit straight with good posture. Sitting in front of a mirror or taking a picture to check your posture can prevent this from occurring.
Musicians who play large instruments [e.g. bass, chello] who find themselves bending over their instruments to play higher octaves often adapt a sitting posture with the bodies weight shifted back onto the tail bone. Remember you want the curve in your low back for the natural support. Your weight should be positioned over your ‘sit bones’.

Strains:

A muscle strain occurs when either a muscle or tendon is pulled, twisted or torn in a way that causes it to be injured.
Tendons connect a muscle to a bone.
A strain can happen because of one event that overstressed a muscle or tendon or it can occur over a longer period of time from overuse of that muscle and/or tendon.

Sprains:

A sprain occurs when a ligament is stretched past its limits of extensibility causing it to fray and or tear.
Ligaments connect two or more bones together.
Normally a sprain is caused by twisting forces or a blow to that joint that pushes it out of its normal position.

How can you prevent low back pain in the first place?

It is important to maintain a healthy, well-balanced diet and to exercise regularly to maintain the strength of muscles, tendons, ligaments and bones needed to support your body as well as your instrument.
Make sure you include strengthening and aerobic exercises [see strengthening handout for more information].
Analyze your posture in sitting and standing, both when you are playing your instrument and when you are not, to make sure you do not have too much or too little curve in your low back as well as your upper back and neck.
When sitting or standing and leaning forward you are placing approximately 50% more stress on the discs of your low back than when standing with good posture.
When playing your instrument or doing other work, balance your time sitting with standing, with standing being the preferred position

Self-help guidelines for low back pain:

If you have back pain that has persisted for weeks or months it is important that you speak with your primary care physician so that you can get the care you need.
When you have low back pain try standing more than you are sitting to relieve extra compressive forces on your spine.
When you are sitting, maintain the curve in your low back by sitting on a wedged cushion and/or placing a pillow or towel roll behind your low back. Do not sit still for prolonged periods to give your low back a break.
When you have to bend down to pick something up, squat down instead of bending from your hips to prevent straining your back.
Perform trigger point release and self massage using a tennis ball or other objects to relieve trigger points and muscle spasms [see trigger point and self massage handouts].

Resources:

The following links and books are good resources created for musicians to help you stay healthy and keep playing!
http://www.actsafe.ca/wp-content/uploads/resources/pdf/msi.pdf
This cite is not specific to musicians but has good general health information to maintain a healthy back: http://my.clevelandclinic.org/disorders/Back_Pain/hic_The_Basics_of_Back_Pain.aspx
Paull B, Harrison C. The athletic musician a guide to playing without pain. 1997.
Horvath J. Playing (less) hurt an injury prevention guide for musicians. . 2010.