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Many pipers will recognize some of the symptoms described here by Elaine Smith. As both a physiotherapist and piper, she is well qualified to alert the ardent piper as to the potential problems which can arise from playing in a cramped or uncomfortable posture. [Space did not permit the full article to be included. Anyone interested in reading the full manuscript should send an s.a.e. to the editor.]

I was asked to write this article after my “posture” workshop at the bagpipe­wrestling gathering known as the “Blowout”. This annual meeting of the Bagpipe Society, held at Lindford Park in Milton Keynes, draws pipers from many disciplines and is, for me, one of the highlights of the year. Blowout 2000 was no exception. I got to hear stunning musicians and music, play along and observe a wide range of assorted bodies going about their normal activities.

As a Chartered Physiotherapist specializing in the treatment of people with musculo-skeletal problems the analysis of body dynamics is automatic and almost an obsession for me. I was very glad to have the opportunity to give some of the Blowout attendees a practical taster in what constitutes abnormal posture, how this develops, what effects arise as a result and, most importantly, what you can do about it. As a musician myself I am well aware of how things go wrong and how difficult it can be to sort it out for yourself.

To understand how our bodies cope with the strains of everyday life it is helpful to have some knowledge of anatomy. Simplistically we are soft tissue around a frame of bones that meet at joints. The joints move, and this movement is produced by muscles. Ligaments support and protect the joints and their surrounding soft tissues. These structures together are often referred to as the musculo-skeletal system.

When unusual or abnormal mechanical strain occurs in the musculo-skeletal system, symptoms such as pain, aching, stiffness or odd skin sensations can occur. Under normal circumstances the natural healing ability of the body will cope and most of these problems resolve on their own. Anything that interferes with the balance between strain and healing ability will result in chronic symptoms that may never recover completely. This may interfere with your ability to play and enjoy your music either because of pain when playing or simply not being able to achieve good technique and adequate control of the instrument.

Mechanism of Strain and Symptom Production

Consider an acute injury like a tom muscle or sprained ankle. The mechanical strain takes the form of sudden over-stretching or excessive compression.

The strain results in tissue damage and the release of an inflammatory chemical soup into the soft tissues. Its job is to stimulate tissue repair. In doing so, though, it also produces a pain reaction whose purpose is to prompt you to rest during the most painful stage of the injury, when to load the affected tissue would create more damage.

Now consider the mechanical strain from inappropriate postures of movement habits which would include poor playing position, inappropriate practice regime and carrying an instrument incorrectly. Here the mechanical stress is again stretching or compression but this time the strain occurs frequently, slowly and repeatedly.

A similar but less severe inflammatory reaction occurs in response to the tissue damage and the body tries to heal itself. Frequently, however, the strain messages being sent from the soft tissues to the brain get ignored because the pain is not severe at this stage. We tend to be less sensitive to information which is clearly not telling us of danger. The healing mechanism cannot keep pace and never really has a chance to get on top of the problem. Loss of flexibility occurs due to build up of scar tissue and muscles weaken from the effects of chronic low intensity pain. This may worsen the situation because it results in stress to previously undamaged areas. Very severe pain and permanent joint damage may be the long term result.

To deal with this scenario you must reduce the causing strain not treat the symptoms. Hence the need for postural correction and the adoption of more appropriate movement habits.

Strain avoidance and control

Identify what you are doing wrong and when you are doing it

Incorporate correct movement habits and positioning into your activities of daily living.

Improve your overall quality of movement including flexibility and balance.

Increase your general fitness and well being.

In doing all this you will be better able to make the most of the formidable self repairing machine that is your body.

Try this postural checklist:- stand in front of a full length mirror in your underwear and look critically at your body position. Start at your feet.

The inner borders should be parallel and about four inches apart. The heel should be in the mid position.

The muscles in the sole should be tensing to support the arch, holding the instep up.

Look at your knees. They should be slightly bent and turned outwards so that, on looking down, the knee caps face forwards and are positioned over the mid part of the foot (tensing your buttock muscles helps you to keep this position)

Now check your hips and upper body.

Shift your pelvis back so that it falls under your shoulders.

Tuck your tai) in and pull in your lower tummy muscles (pulling up your pelvic floor or bladder muscles as if stopping peeing will help you to identify where these are. Do not.use more than 20-30% effort).

Lift your chest up and forward increasing the distance between the base of your rib cage and your navel.

Keep your shoulders relaxed and with your arms by your sides (getting the correct shoulder position is often the hardest for musicians and you may need professional help with this).

Drop your chin slightly so that your head is balanced midway over your neck, then raise the crown of your head upwards. This shifts your head and neck back over your shoulders and brings your face parallel with and brings your face parallel with an imaginary vertical line [see diagram].

The overall effect is to lengthen the spine upwards and align the spine and limb joints correctly in relation to the central line of gravity ie the “plumb line”. In the correct position your body weight should be spread evenly

between your heels and the balls of your feet/base of toes. If you can easily lift the front part of your foot your weight is too much on your heels. If your heels lift easily, you are leaning forwards too far.

The figure illustrates idea) alignment.

The plumb line passes just behind the ear, through the hip joint, towards the front of the knee and just in front of the ankle.

This position results in even distribution of weight through the spine and a neutral position of the joints.. Although some muscular effort is required to maintain it, this can be achieved and held by the postural muscles at low effort. It is, therefore, relatively efficient with minimal mechanical strain.

We also have to contend with side to side position and twisting relative to the plumb-line, together with the effects this has on limb position and control.

A mixture of positional faults can occur in the same individual simultaneously and may give rise to symptoms a long way from the problematic areas. These symptoms are often described as repetitive strain injury/work related upper limb disorder or cumulative strain disorder. They are particularly relevant to musicians who may spend long periods in one position doing a repetitive action or suddenly being called upon to perform for longer periods than they may be used to.

It is important to consider spinal position when doing things other than standing. We spend a great deal of time sitting. Inappropriate seating may encourage poor spinal position. Musicians may easily fall foul of this when playing both at home and out at sessions or performances. Try to ensure that the chair you sit on enables a 90° angle at hips, knees and ankles with support in the lower back.

Achieving a good position can be made more difficult by other external factors such as a too short bellows connecting pipe. Anything that encourages increased rounding or flexion of the upper and lower back will bring your arms into a less than ideal position.

Correcting your faults. A good place io start is to aim for an alignment as shown on the previous page, whether you play sitting or standing. Go through the postural checklist and incorporate all the leg and lower trunk correction measures first. This gives you a better base of support on which add the upper body and shoulder girdle changes. Then, add in the upper body corrections and practice holding the position and getting familiar with what it feels like. Finally, strap yourself into your instrument and repeat the whole process. Choose an easy tune that you know well and practice the correct posture whilst playing. (Maintaining the right posture during playing requires muscle stamina and different manual dexterity. This needs to be built up slowly by repeated practice in the same way that it takes time to learn a new tune).

When correcting everyday postures I usually suggest a frequency of correction of every 10 minutes for the first three days. Using an alarm watch of kitchen timer is a good way to remind you to do it, but can be unpopular in sessions!

After this aim to concentrate on three activities other than practicing your instrument that you perform at regular intervals during the day e.g. driving; siting to eat; climbing the stairs. In this way you will be able to create a structure that keeps you conscious of the correction process and teaches your muscles the necessary correct patterns of activity previously mentioned.

Changes in posture and movement patterns will inevitably produce transient aches and pains from soft tissues adjusting to new tasks. These should settle within a week to ten days without any overall worsening of any symptoms that you may already have.

If you are in any doubt about what you should be doing seek professional help. Take your instrument with you to the consultation so that the therapist can assess your position whilst playing and record the advice you are given. It makes it much easier to practice later.

Footnote You can also reduce strain on your arms and upper body by lifting correctly and taking care when cairying. Carty heavy objects close to your body, with arms tucked into your sides. An instrument case should hang by your side, supported with your fingers in a relaxed hook grip. Your elbow should be straight with your hand in line with your forearm.