Welcome to another exciting edition of “muscles you’re using wrong”. I got some really great feedback on my first entry in this series, Calf Edition, so I’m back for round two: THE NECK.
The photo of the deep front line below, from Anatomy Trains, serves as a nice visual intro as to how the neck can become a common lieu of muscle compensation. You can see how the neck muscles are fascially connected in a chain to the diaphragm, torso, legs and feet.
A brief primer on muscle compensation as it relates to dancers: Before many of us learned to move fundamentally- squat, lunge, pull and push- we learned complex dance movement. This is especially true if you started dance when you were but a wee toddler. As a result, dancers can easily develop dysfunctional stabilization strategies, and learn to create movement from random places that have no business getting involved.
As babies, one of the first fundamental movements we learn is to lift our heads, making neck function kind of a big deal.
In calf edition, I outlined how foot-pointing all day every day can cause the plantar flexors (muscles of foot-pointery) to become majorly involved in movements they needn’t be. I personally have seen (and experienced n=1) how various muscles of the lower leg can compensate for the glutes, hamstrings, quads, psoas and more. This not only can disrupt movement pattern quality, but can eventually lead to painful movement.
Today it’s all about the neck. For me, this is huge- If I’m not careful, my body instinctively tends to stabilize with my neck muscles instead of my abdominals. This is common in many dancers and non-dancers alike.
My brief neck injury history: While half-asleep, on the morning of opening night of a show, the mere act of turning my head to the side caused an intense sternocliedomastoid spasm that incapacitated my neck for 3 days. My neck was so overworked, most likely from it’s unnecessary usage as a whole-body stabilizer, that I injured it not while dancing, but while luxuriating in the dreamy bliss that is the first 10 seconds of waking. Not a great start to a day, AND I couldn’t perform in the show.
Why did this happen?
As I mentioned above, your neck CAN get more jacked than your deep abdominals. This can become a complicated topic, so for the simple purposes of today’s post, we will look at how the neck flexors and extensors can inhibit the transverse abdominis from properly stabilizing your body.
It starts with that deep front line Thomas Myers presents in Anatomy trains. Check out the awesome video below in which you can see the deep front line dissected from the body. Very cool stuff, fascia is.
And T. Myers is a fox.
In the deep front line, the deepest of the body’s stabilizers are intimately connected fascially, sharing a neural and mechanical network, making it easy enough for one part of the line to compensate for another in the presence of acute trauma or from just moving like crap over long periods of time.
Another imbalance can occur within the neck itself between the flexors (in the front) and extensors (back): If the neck extensors become too overworked and tight, the neck flexors can become weak. This happens easily in our society of texting, computering, and other things that make us slouch and adopt a head forward posture. An oversimplification of neck imbalances, but still significant to understand.
While repositioning the head is very important, in today’s post we’ll be talking mainly about how this poor neck posture can cause the neck flexors and extensors to become recruited for core stability instead of the transverse abdominis (TVA). A poor strategy.
As a funny, but non dance-related aside: The other day at the gym I was witness to a trainer and his client as they took their monthly body part progress measurements. They remarked at how all his various muscles had not changed in girth (the goal was to get more jacked), EXCEPT FOR HIS NECK, which had increased in size. They brushed it off as “haha that so weird”, but I noted his forward head posture and his poor core stabilization patterns and guessed that his neck had grown because it was probably doing more work than any other muscle.
Food for thought… But back to business.
I see two common situations in which the abdominals can become downregulated to the dominant neck musculature (though anything is possible, not just these two scenarios):
1. Sternocleidomastoid (SCM) compensating for transverse abdominis (TVA)
This one is MY pattern- Neck flexors stronger than TVA. In a perfectly functioning body, if that even exists, before we even move the TVA fires to stabilize us. However, some of us activate our SCMs first for that job.
These people have forward head posture, and will often also have jaw tension and SCMs that you can see pop out (because they’re so jacked). Like in the dancer below.
2. Neck extensors and suboccpitals compensating for TVA
The neck extensors stronger than TVA pattern represents the chin-pokers and shruggers. I personally see this less commonly in my dance clients than the above neck to core compensation. The SCM’s seem to be bigger culprits in compensation and I am not 100% sure why.
Here’s simple way you can assess which scenario is you, using the deadbug exercise as a reference.
Here’s the basic arm and leg deadbug:
Try it 3 ways.
1. With your chin poked up to the ceiling, neck extended (to engage neck extensors).
2. With your head lifted off the floor, chin tucked, looking at your knees (to engage the neck flexors).
3. With your neck in neutral, looking right up at the ceiling, neither poking nor tucking the chin.
The neck position in which the deadbug feels more solid and less shaky is your compensation pattern. For me, I crush deadbugs all day if I lift my head up and look down at my knees. But with my neck in neutral I’m shaky and unable to keep my spine neutral.
If you are already strongest with your neck in neutral, then you have nothing to worry about. You rock. And I hate you.
How to reverse your pattern:
DISCLAIMER: I can only provide a general strategy for this issue, nothing more. I don’t know you, and can’t assess you magically through this blog post, but I can easily assume that if you dance you have some kind of neck to TVA compensation, and this will almost certainly help you to reduce some neck tension and improve core stabilization, so that you can dance better and not hurt your neck in random silly ways like I did.
Step 1: Neck stretch. To downregulate the muscles of the neck which may be overworking. Breathing deeply and feeling the neck relax is the key to actually getting some benefit from this stretch.
Step 2: Head lift. To reposition the head back in line with the rest of the spine. You can also put your hands at the base of your skull to feel if you are tensing your suboccipitals and poking your chin up. You should be aiming the back of your neck up to the ceiling, NOT poking up your chin.
Step 3: Deadbug. Again, this time as an exercise, not an assessment. To activate and strengthen the TVA while the neck has been freshly downregulated. Do your best to feel your neck is relaxed, and only do only as many reps as you can before you feel like your neck is starting to tense up and do the work.
Start with that. Repeat. Do it daily if necessary.
If you want to take it a step farther, get assessed by someone who understands dancers, get manual therapy on your neck if you need it (always fun), and then get a movement specialist to coach you through your core training and provide you with a full-body strength training program which will integrate correct neck and core patterns.
For more on neck compensation, check out this great article from Dr. Perry Nickelston on his blog, Stop Chasing Pain, in which he describes how the neck can compensate not only for the TVA, but for the obliques in their role of creating rotation.
I’d love to hear if you’ve found this info helpful. Give me your feedback in the comments below to keep the discussion going.
A little while back, Bizz Varty wrote an awesome two-part article for me on the topic of the sacroiliac joint- That fun little joint where your sacrum and ilium meet.
Though it’s a topic that’s already been given some deserved attention, I feel as if it’s time to touch on it again (though I’m no SI joint whisperer, like Bizz claims to be). And if you’re reading this, Bizz, I’m still waiting for my magical SIJ adjustment ;).
There are a couple of reasons that I’m dedicating another post to the SIJ:
1) Bizz’s original SI joint article continues to be one of the most popular ones on my site. I’ve even had some readers email me out of the blue asking what they can do about their SI joint issues after having read Bizz’s SIJ saga. Clearly, this is something people want to know more about, and who am I to deny the people what they want??
2) I recently took an online seminar, presented by Rick Kaselj, and learned a bunch of cool stuff about SIJ pain, and exercises to eliminate said pain. I’ll be quoting a lot fun facts I learned from his presentation. Rick is a super smart guy, an I can honestly say I wouldn’t know half of what I know today if it weren’t for him and the great information he makes available to industry professionals like myself.
3) My SIJ has been bothering me for about a month now, and I know exactly why, and I’m going to share it with you, and what I’m doing to help it.
4) All the dancers I’ve worked with recently seem to have at least one funky SIJ. And it’s usually their right one.
So here we go! Here’s to hoping I can live up to Bizz’s glory. I’ve got some big shoes to fill. She did a really good job outlining the anatomy stuff in her article, so I’m not going to re-hash it all. And if you haven’t read it yet, CLICK HERE and then HERE. Seriously, it’s about time.
As I mentioned, I have been dealing with a bit of a cranky SI joint lately. I have a couple of educated guesses as to why:
1) I have been training harder and heavier than usual.
2) I have been sitting at my computer more than usual.
3) I have been paying less attention to my pelvic alignment.
4) I have stopped doing nearly all extra core training.
5) I’m probably more stressed than I realize.
6) I am a woman.
In case you didn’t know, women are more susceptible to SIJ pain than men. This is because of that thing called child birth. Remember that thing? The ligaments that stabilize the SIJ are more lax in women so that we can do that child birth thing one day. Less stability= more susceptibility to getting hurt.
Women also naturally have a higher degree of anterior pelvic tilt than men, which puts more stress on the SI joint. This is why paying close attention to alignment and doing an appropriate amount of core training is essential for us ladies, and especially dancer ladies.
Why is SI joint pain and dysfunction such a big deal?
Well, it hurts, so that sucks. But our SIJ’s have a pretty important role- To transfer force from the upper extremities to the lower extremities. And the reverse. Force transfer is important for any kind of athlete. Also if you like having fun, playing sports, or tipping cows.
What does SI joint pain/dysfunction usually feel like?
SIJ pain is usually lumped in the broad category of “lower back pain”, and can be characterized by a radiating pain around the lower back and bum area.
Bizz mentions a couple of cool assessments you can do on yourself to determine whether or not your low back pain is coming from the SIJ, so I won’t get too into that. Also, if you have lower back pain, your first move should be to see a professional about it to determine a proper rehabilitation program. That said, one assessment I generally do when working with someone is a little Thai Yoga Massage move called the “hip hop”.
This is Albert (Krishna), one of my Thai Massage teachers, teaching at the Sivananda Yoga Center here in Toronto.
Those Thai were trying really hard to mainstream when they named that one… But anyway, this particular Thai Massage stretch not only feels awesome (because it wiggles the SIJ around), but based on how much movement I can get in the person’s SI joint, I can tell how jammed and unstable it is, and which side is more affected than the other.
In dancers, I’ve noticed that the right side is generally less stable, with less movement and more pain. In my experience, dancers also tend to have more external rotation in their right hip. This is because in dance classes we end up practicing things more on the right side than the left, and so we develop more turnout on the right side, which causes the right piriformis to get super tight, pull on the SIJ, and cause pain.
This leads me to…
What Causes SI Joint Pain?
In Rick’s seminar (who, by the way, knows way too much about every injury), he listed that the SIJ is most commonly injured by:
2) Pregnancy/child birth
4) Repetitive movement
5) Leg length discrepancy
For dancers, and other super active people, the most probable causes are muscle imbalances created by overuse and repetitive movement. I would also add prolonged poor positioning, or shifty alignment, to that list, but this can be lumped under repetitive movement.
The most common muscles associated with SIJ pain are glute med and max, piriformis, quadratus lumborum and biceps femoris. These muscles stabilize the SIJ. When stability is compromised due to an increase of stress on the joint, they tighten up to try to add more stability.
What Can You do About Your SI Joint Pain?
First, stop doing the things that make it hurt, go see a specialist, and get some rest. And then you can start doing some of these things:
1) Find neutral spine. Find it and start walking around in it all day every day. I cannot stress how important alignment is if you like not being in pain all the time! Being in the proper alignment will take stress off the SI joint and strengthen the muscles which stabilize it. Start now. Find neutral spine and use it as often as you can. How?
I like to find neutral spine by using a little trick I stole from Dr. Stuart McGIll: Bend forward about 45 degrees and put your fingers on your low back erectors. They should feel hard and activated*. Begin to bring your back into an upright position, but stop when you feel your lower back muscles first relax. This is neutral for YOUR spine. Now hold onto that position with your pelvis and bring your ribcage back over it if you feel like you’re leaning way forward.
Sam is so awesome for always being my “exercise model”.
I tend to always be in too much anterior pelvic tilt (sway back posture), so being in a neutral pelvic alignment is important for me if I want to be pain-free and happy. Which I do. This trick worked wonders for me and taught me how to properly engage my core, glutes and hammies.
After you’ve mastered finding neutral spine (read, have become obsessive compulsive about using it all freakin’ time), strengthen it! Learn to deadlift with perfect form, and start deadlifing everything from now on.
There is no more “pick up from the ground”. There is only deadlift.
2) Get some core stability. Specifically, learn to activate the transverse abdominus and the deep pelvic floor muscles. Not only do you need strength and endurance in your core, but a little fine motor control don’t hurt either. Your core muscles stabilize your SIJ. More stability is good!
Stable joint=no pain
Unstable joint= pain
Mike Robertson, from Indiana Fitness and Sports Training, wrote an article called Core Training For Smart Folks, which you should now go check out. If you’re smart…
3) Learn proper hip extension. Get a friend to check out your hip extension skillz by doing a simple single leg hip bridge. If you notice that there is significant arching in your lower back, and your chest is rising to your chin, and your bum is still squishy, then you are doing hip extension from all the wrong places.
4) Self Massage. Most of us can’t afford to get weekly massage therapy. Luckily, you can still get a good amount of benefit from self massage You may need to do some self-massage on your problem areas 3 times a day at first, and then reduce the frequency until you’re just maintaining whenever you feel a flare up.
I forget who I heard it from first, but I like the saying, “Doing self massage between massage appointments is like brushing your teeth between seeing the dentist.”
My favourite items to self-massage with**:
Great for hitting the piriformis, glute med and max, lower back, and QL area. If that’s too intense, use a tennis ball, or a less dense rubber ball from the dollar store.
Use it for the above if using a lacrosse ball is too intense. Also for your IT bands and upper back. I’ve never tried it, but I hear you make your own roller out of various other hard objects wrapped in other various softer coverings. Try wrapping an unopened soda bottle, one of those Nalgene bottles, filled with water and frozen, or some PVC piping wrapped with bubble wrap or that non-stick rubbery stuff you put under tablecloths.***
5) Static and dynamic stretches. Perform dynamic stretches for the culprit muscle(s) before you do any kind of moving for the day, and static stretches after you’re done your day’s work.
Dancers be careful with your hamstring stretching! Many people have tight hamstrings as a result of SI joint pain, but dancers actually have pretty darn flexible hamstrings, and seem to be obsessed with stretching them. In my experience, dancers can benefit a lot more from strengthening the hamstrings than stretching them more, as they are one of the more common dance injuries. One that is close to my heart, so to speak.
6) Improve thoracic mobility. If you only move from one point in your spine (probably the lower part), then all the stress will accumulate at that point. If you can learn to move from multiple points on your spine, the stress will be more evenly distributed.
And that’s all she wrote.
For more on exercises and strategies for developing strength and changing the way you move, check out my resource, Dance Stronger.
*Yes I realize I just used the words ‘hard’ and ‘erectors’, almost in the same sentence. Sue me.
**Sue me, again…
*** If anyone tries to make their own foam roller, I want to see a picture of it! Success or fail.
Today I am pleased to share with you a guest post by a fellow dancer, pilates and yoga instructor, performer, and self proclaimed SI joint whisperer, Bizz Varty. When she contacted me to write something for the blog I was thrilled, and I had no idea how much shit was going on down in my SI joint until she pointed out to me how common it is for that pesky guy down there to be jammed and angry.
Without further adieu, here’s part one of Bizz’s epic tale of the mysterious little bugger that is the sacro-iliac.
The SI Joint Whisperer Tells All (and encourages you to loosen the f#$% up!)
By Bizz Varty
The sacro-iliac is quite possibly the most mysterious and misunderstood joint among dancers. As a dancer and a yoga teacher, when I hang around with my dancer friends, I spend a lot of time releasing stuck, jammed and pinched sacrums (they call me the SI joint whisperer). As delightfully satisfying as a recently-released SI joint can feel, (note from Monika- BEST. FEELING. EVER.) I have realized that constantly putting it back where it came from is like using a cup to catch water from a leaking bucket just so you can pour it back into the bucket – that is, rather inefficient. This realization plus my own lengthy history of pain in the posterior hip and spine have led me on a search for long-term solutions in the form of alignment, conditioning and neuromuscular re-patterning.
An injury back in high school began my long journey to understanding my SI joint. I was dancing every night as well as playing soccer, and woke one morning with a pain in my back/hip, a pain that eventually moved into my knee.
For weeks I felt I’d ‘lost my bounce’, because jumping sent a ricochet of pain all the way from my toes to my neck along my right side. Being young and stubborn, I did not seek medical attention or even apply an ice pack. Instead, I just tried to dance it off. Though the intense pain eventually went away, my right hip and knee were never the same. Fifth position and attitude derriere caused pinches and twinges in my back and I constantly had an incredibly tight IT band.
But I continued to dance anyway (See Monika’s article “The Problem with Dancers Today” for more on this).
For three years I was held hostage by the twinges, aches and pains that seemed to move around to a different part my body every week. Then, in my second year at York, a ballet teacher suggested that maybe one of my legs was longer than the other. Intrigued, I went to a physiotherapist who said that they were, in fact, the same length, but my SI joint was stuck on the right side.
That first SI adjustment changed my life – for a few weeks anyway. Not knowing that this was something I would eventually become very passionate (ok, maybe a little obsessed) about, my early efforts to maintain this new and wonderful SI joint balance were half-assed at best. Going to physio each week became more like going for an SI release every week. That is, until my PT got fed up and showed me how to release it myself. Then, she began teaching me how to activate my deep core muscles, which blew my stubborn dancer’s mind.
In the 6 or 7 years since, the amount of attention I’ve paid to the problem has varied in relation to the wide assortment of injuries and misalignments I encountered. I would try to dance (or swim, do yoga or even walk) with my SIJ locked. Then, I would have to spend several days dealing with the after-effects only to have it happen again the very next week.
I learned the hard way that the best offense is a good defence, and began addressing my SIJ with daily re-patterning work about a year ago.The improvement has been magical.
Certain activities (especially if done when tired or distracted) will still throw my SIJ off, but now that I know the symptoms (non-specific pain in my knee and IT band) and the solutions (I live for pelvic smile and seated fourth release!) I no longer suffer daily from the repercussions of poor patterning.
My method may not be the simplest, but I find it very effective, as do many of my students. Stabilizing your SIJ, especially if you are a dancer who expects your body to maintain a large range of motion, should be a daily practice. Tight muscles will pull the SI out of alignment, and the body’s compensatory efforts will keep it stuck there.
If you have SI joint issues, chances are good that they are supported by years of well-intentioned but inefficient movement patterns. (Note from Monika- I agree… the road to dance injury is paved with the best of intentions).
I don’t say that to discourage you, I say it to help you understand that you can’t half-ass this if you want it to work. Trust me on this one, I’ve lived through the drama and made it to the other side. A happy SI joint will improve your movement in a million little ways that you can’t even imagine until you’ve experienced it. It takes some time and effort to find what works for you, and to figure out how your body tells you that it needs attention, but it is SO worth it!
Anatomy: What is the SI joint and how does it work?
The Sacro-Iliac joint is in fact two joints – one on each side of your sacrum where it meets the back of your pelvis – specifically, the inner edges of the ilium. You can find these spots by looking for the dimples at the back of your pelvis (just above the crease between your cheeks). The bump you will feel near each dimple is your PSIS or Posterior Superior Iliac Spine – anatomy-speak for “the bony bump at top of the back of your Ilium.” The SIJs are weight bearing joints that provide shock absorption for your spine and distribute the weight of your upper body onto your pelvis and into your legs and feet.
There is some misinformation out there that states that the SI joints do not move, but in a healthy body this isn’t true. To be fair, the SIJs are not designed for a large range of motion as they are stabilized by many deep ligaments. Especially in the type of loose-jointed (which is to say, long-ligamented) bodies that dancers tend to have the bones do move in relation to one another, and when they do they cause widespread (though usually subtle) shifts in overall alignment. Rather than a ball and socket joint like the hip and shoulder, or a hinge joint like the elbow and knee, the SIJ is a gliding joint, more like those found in the spine, where two relatively flat articular surfaces slide against one another. (You can find out lots more nerdy pelvic anatomy stuff on Wikipedia if you’re interested!).
So, if your loose ligaments aren’t holding the SI joints stable, what is? That would be your deep core muscles, namely the transverse abdominus, multifidus, piriformis and ilio-psoas. But there are a number (some say as many as 35) of other muscles that have a connection with the SIJs including the gluteus maximus and minimus, erector spinae, latissimus dorsi, quadratus lumborum (QL), hamstrings, quadriceps and tensor fascia latae as well as the IT band. You would think with so many supporters the SIJs would be good and stable, however all of these muscles also have other jobs to do when the body is in motion, and when those other jobs take priority over SIJ stability, it can throw all kinds of things out of whack.
Side note: SI joint dysfunction is sometimes called “piriformis symdrome” because the piriformis in one of the primary culprits for malfunction, especially in dancers who overwork their turnout. While piriformis syndrome may well be caused or aggravated by SIJ dysfunction, it is a distinct problem that affects only a small portion of the general population. In less than 20% of bodies, the sciatic nerve runs through the middle of the piriformis muscles (instead of underneath it) and when the piriformis is overly tense it pinches the nerve, causing a radiating pain down the back of the leg. The only way to determine if you fall into that 20% is by cutting your butt open to take a look so you may never know for sure, but if you have a shooting nerve pain that starts in your buttocks, you can bet that your sciatic nerve is being irritated by your piriformis.
Symptoms – What do unstable SIJs feel like?
SI joint instability is a bit of a misnomer. What I see in many dancers are SI joints that have become locked into place by tight, weak muscles. In an effort to protect what is an especially loose joint in dancers, the body tenses up resulting in a joint that is in fact too stiff for its own good.
As I said before, the SI joints should move, not a lot, but just enough to transfer information from the pelvis and legs to the spine and back again. When this doesn’t happen, because the joint has locked into place in the interest of self-preservation, pain can sometimes be felt at the back of the hip near the dimples. But the body is crafty, and in a dancer’s loose body, the spine, pelvis and hips can shift subtly to work around the blockage. In cases like this, pain might not be felt at the SI joint at all. Rather, the over-stability there will cause instability in other locations – typically in the front of the hip, the low back and the knee, but sometimes all the way down to the toes and up into the neck. (For me, I don’t feel anything in my SIJ until after I notice a pain in my knee).
Usually the piriformis, and often the QL and glutes will be very tense, (Note from Monika- Yep. So. Tense.) and could even be in spasm. To make it more complex, a problem with the right SI joint could very well cause pain in the left side of the body, as the brain will just reassign whichever nearby muscle is strongest to cover for the weak ones that are busy tensing up to create more “stability” – essentially, to use the technical term, an “anatomical cluster-f#$%.”
Try this at home: If you suspect your SI joint is locked, you can get a friend to try and help you determine on which side. Standing tall with the feet parallel, have your friend stand behind you and place their hands on the SI joints, just above the dimples. Raise one knee to hip height slowly, then lower. Repeat on the other side. If your friend feels the SI joint lift upwards when you raise your knee (instead of staying still or moving down slightly) the SI joint may be locked on that side.
Causes – What makes dancers so vulnerable to SIJ cluster-f#$%s?
Most people are stronger in the outer hip and weaker in the inner thighs as a result of sitting for long hours and standing with poor posture. Dancers tend to be looser-jointed than the average population, as the dance world has a way of discouraging those less flexible folks. Add to that the dancer’s affinity for overusing the outer rotators to create more turnout as well as a penchant for general over-exertion and you’ve got a recipe for SI disaster. The SI joint was simply not designed with turnout in mind, as most mammals move most efficiently in the saggital plane. But that’s not to say that dancers and their SI joints can’t be friends. In fact, you too could very well become BFFs with your SI if you regularly practice the exercises which will be outlined in part 2.
(Note from Monika- I will post part 2 tomorrow, which is full of fun stuff to show your SIJ some love)
Check out the free 30 Day Core Challenge. It’s a great way to get back in touch with the fundamentals of “core” (do you know what they are?), which, as you now know, is an important component in SIJ happiness. All you need to do is make time every day for a few minutes of practice for 30 days. Simple 🙂
Here’s a little about Bizz:
Bizz (Elizabeth) Varty has a passion for dance, music and mind-body fitness. While completing her Honours BFA in Dance at York University she discovered her love for dance science and kinesiology. She also studied Arts Management at Humber College and is certified as both a pilates and yoga teacher.
Bizz has studied dance for more than 20 years. She has choreographed and performed across the province including her 2009 work, the Janis Joplin-inspired piece Honey, I Know How You Feel for the BAZAAR dance festival at Toronto’s Opera House. Along with Beth Lifeso, she is co-director of Cocktail Dress Productions, who have performed at Massey Hall and The Rivoli in Toronto.
Her interest in fitness began at a young age and she has been practicing Yoga and Pilates for 15 years. Her teaching style combines the precision and efficiency of pilates and the philosophy and flow of yoga with the creative expression of her dance background. Bizz’s attention to anatomical detail and her fun, engaging instruction have earned the respect of students of all ages and backgrounds. For more info and free videos, visit www.basicfitness.wordpress.com.