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DavidJE
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[*] posted on 4-26-2014 at 11:45 PM
Oud Playing & Lower Back Problems


I'm wondering if anyone here has had lower back issues they can connect to playing the oud.

I should preface this by saying that I'm in above average shape, exercise a lot, and have never had lower back problems before. I'm 39.

I've been playing the oud for about a year, and I typically play for ~2 hours/day. After 3-4 months I started having lower back pain, but it started a day after I took a hike down a steep mountain path, where I noticed some discomfort. It continued for about 6 months before I went to a doctor, as I figured it would go away on its own. But it didn't. I had x-rays done and the doctor said there is "hyper-mobility" in my L5 vertebrae, causing my ligaments and connective tissue to strain. So I've been going to physical therapy for a while now, but thus far it doesn't seem to be helping. However, my back issue is not so bad that it stops me from doing the vast majority of things I did prior.

Yesterday I played my oud more than usual though, and today I woke up with the worst back pain I've had so far. It hurts just to walk or sit. And I really didn't do much else yesterday.

I did wonder originally if my back problem could be related to sitting and playing my oud, where I tended to "lean" just a little to my right...and the pain is just to the right of my spine. The doctor and physical therapist said it was unlikely. But after playing a lot yesterday and having it feel particularly bad when I sit to play today...I'm wondering.

So, have any of you had any lower back issues that you think could relate to playing the oud? Or, maybe bad playing posture?
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[*] posted on 4-27-2014 at 03:57 AM


What is your posture when you play. I use a fold-up chair and a foot stool for my right foot that allow me to sit back and relax. Without that setup I would have been hunched over and definitely would aggravate the back. Sitting for 2 hours is not good either in any position.

I do computer work all day so I know exactly the pain you are talking about. Stretching the lower back and hamstrings is critical. See a chiropractor they'll set you straight.
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[*] posted on 4-27-2014 at 05:06 AM


I THINK my posture is good. I try to sit straight up. My back doesn't rest on a chair back, and I try to remain balanced. Sometimes thought I do find myself "hunching". I'm trying to eliminate that.

I do a lot of stretching. I can easily put my palms on the floor without bending my knees, and can basically hug my legs, so my lower back and hamstrings are plenty flexible. For most of my life I taught self defense/martial arts. The doctor told me that the injury I have is common in gymnasts...the "hyper mobility"...and it may stem from being overly flexible, or moving too much years ago. I guess I don't think the oud playing was the root cause of this, but I wonder if it's making it worse...and if there is something I should change...which is why I was curious about other people's experiences with oud playing and their lower backs. It's possible that this has nothing to do with playing the oud.
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[*] posted on 4-27-2014 at 05:19 AM


I find it hard to believe that someone who is physically active and fit, as you sound, would have problems like this caused by oud playing unless your posture is really bad. Most of the time I play using a footstool like hussamd but sometimes I sit cross-legged or even cross-legged on the floor. It just depends what is comfortable for me. Whenever I feel even slight discomfort I immediately change position to something that feels natural.

To me it sounds like the oud playing is exacerbating an already existent problem. But I would certainly agree that two hours is too long to be playing at one go. It might be worth splitting your playing time into two sets of an hour with a decent break in between.
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[*] posted on 4-27-2014 at 05:36 AM


Thanks guys.

I feel the same way Lysander. As I mentioned in my first post, my doctor and physical therapist both said the oud was unlikely to be the cause or even a problem. But I figured it wouldn't hurt to ask on the forum, since neither of them even knew what an oud was. Actually, I might bring it to my physical therapy on Tuesday.

I generally do take breaks between playing. On normal days I'll play for an hour in the morning and an hour in the evening. On the weekends I often play more than that, but I do try to get up and do something else after 45 min. - 1 hour.

Originally I played some sitting cross legged on the floor. I figured the oud was probably designed by people who played sitting that way. I may try that again too, as I did enjoy it.
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[*] posted on 4-27-2014 at 07:29 AM


I very much doubt that your back pain is being caused by a hitherto undiagnosed "hyper-mobility" in one of your vertebrae. The fact is that most people over 30 have some similar structural defect in their back, but only a small number of those people have back pain. I do think that playing the oud can cause stress on the body, especially in the first few years when you are still developing proper technique. Many people have shoulder pain, but back pain is not surprising.
There may be nothing wrong with your posture, but other stresses involved in playing may be causing you to tense up muscles in your back—everything in our body (including our brain) is connected, and the manifestation of pain is not always obviously the origin.

How do you feel about your progress on oud in general?




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[*] posted on 4-27-2014 at 08:17 AM


Brian... Well, the pain is in a VERY specific spot, and it came about after a day of hiking on a steep mountain, where I felt my back wasn't doing so well. The doctor said that the hyper mobility caused excess stress on a ligament, which is what I damaged. I'm just not sure what caused the hyper mobility for sure, and if I could be exacerbating it by playing, etc.

I'm taking Skype lessons with Mavrothi once a week. I've been doing that for the last ~3 months. And especially due to the lessons, I'm very happy with my progress. :)
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[*] posted on 4-27-2014 at 09:51 AM


If I am understanding you correctly, you have had this pain for ~8 months? How long have you been seeing the physical therapist for?
While you are probably right about the hike being the original trigger for the pain, it is not very likely that a stress on your ligaments and connective tissue would remain painful 8 months after the triggering incident. It's possible it's something else, or as you guess that playing the oud might be interfering with healing.

Have you taken any time off from the oud during this time? I would suggest taking a few days off from the oud here and there and see if you notice any changes in the pain. It could also be caused by something else, such as sitting at a computer too much, etc. My main point is that in cases like this, the doctors are basically guessing—they have no way of empirically determining the cause of your pain. They note a structural abnormality and point to that, but it is basically a guess. There have been studies that demonstrate this pretty clearly (i.e., that doctors are just guessing). There is a strong confirmation bias in that people who are not in pain don't go to see doctors, so that doctors have a mistaken sense of the correlation between abnormalities and pain (ie., they have no sense of the background prevalence of abnormalities in the population of pain-free individuals). I mainly make this comment in the event that you are considering any kind of surgery to correct your vertebra. Physical therapy is relatively risk-free and the treatment protocol is not really dependent on the specific diagnosis.

To answer your original question—it is not uncommon for people to develop back and shoulder pain from playing the oud, especially early on (first 1-3 years) as they learning.




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[*] posted on 4-27-2014 at 01:20 PM


Brian... Yes, I've had it for about 8 months now. I've only been seeing the physical therapist for a few weeks.

I have injured and torn ligaments before, when I was teaching. I know they take a long time to heal. So my thought was that if I did injure or partially tear a ligament, that could be the cause of this long standing pain. My physical therapist said that the area I have the damaged ligament in gets little blood flow naturally, so it takes a long time to heal. He has been doing some kind of pressure/trigger point massage to increase the blood flow, and having me do certain exercises (which I doubt are making much difference). Honestly, I don't think the physical therapy is working. In a few more weeks, if there isn't significant progress, then I'll be going back to the doctor for an MRI.

I have not taken time off playing the oud. But I'm about to go on vacation for a bit over 3 weeks, where I won't have it with me. I also won't be sitting/working much. So I'm curious to see what impact that has. When I do work at home (I'm self employed), I stand more than I sit. I have a standing set up for my computer, and alternate between standing and sitting.

I agree with what you've written regarding diagnosis, etc.

Originally I did have a feeling that playing my oud was either making the situation worse or hindering the healing. But I think that was because I tended to play in an unbalanced position, leaning a bit to my right side. I THINK I've mostly corrected that. Other than playing a lot yesterday and having relatively bad pain this morning, I haven't been able to correlate playing my oud with an increase or decrease in pain. It would be terrible if I couldn't play the oud! It has become my favorite thing to do. Although, I'm sure I could find a solution...different way to play.

Generally, this isn't something that changes my life. But I'm somewhat concerned that it could get worse (as it was this morning), and I'd like it to be better. It has hampered my weight lifting/exercise, as I can only safely do what I used to use as a warm up for a couple of my favorite exercises (squats and dead lifts), and I want to maintain my level of "fitness". Anyway, I'll see what happens when I have some time off.

BTW...I am not considering surgery. In the past I have had doctors tell me injuries would not heal without surgery, but they did eventually heal. I'm hoping the same for this. For previous injuries I used to use various external analgesics that seemed to help. I'm going to try that too, hoping it could increase blood flow and speed the healing process.

Thanks for your thoughts and advice!
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[*] posted on 4-27-2014 at 08:06 PM


Well, increasing blood-flow is good, so if that's part of the PT regimen I think you are on the right track. Straight-up massage therapy might also help. Great to hear that you have a standing setup for your computer—I wish I had one.

I don't think you'll have to give up the oud, but a period of less regular practice might not be a bad idea. I actually think it's good sometimes to do that anyway, and refocus on more core musical skills—transcribe some songs or taqasim, work on singing, visualization, etc. Mental practice can be even more helpful than physical practice sometimes.

Have you tried Yoga? It is really very helpful for this kind of stuff, and a good way to keep active when other activities might be problematic.

I understand that an injured ligament might take time to heal, but an injury that would take 8 months to heal would most likely have had a very clear precipitating incident, and would gradually feel better over the long term rather than randomly better/worse.

Do you practice in front of a mirror? I find that very helpful for observing problematic posture and habits that might otherwise not be obvious.

The 3 week break should be informative. I had more in mind giving yourself 2 days off, 2 days on or something, but if the 3 weeks is happening anyway, you will hopefully get a sense of what might be triggering the pain.

Good luck!




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[*] posted on 4-27-2014 at 11:44 PM


I have not tried Yoga. But, the stretching exercises my PT had me do are similar to Yoga exercises, and they made it worse. They involved stretching my spine. The exercises he has me doing now are small movement coordination exercises, to get me to become more aware and coordinated in that area on a regular/normal basis. He has also given me a number of pilates types exercises, but since my back is fairly strong anyway, they're easy, and I feel they don't make much difference. What really helps is the massage. When I go in he has me lean back and tell him when it begins to hurt. (Leaning forward doesn't hurt, it's only leaning back.) And after the massage, the pain is almost entirely gone...I'm able to lean back with no pain.

I do use TRX straps in my regular workouts, involving "plank exercises", etc., and of course with the TRX you are always working on core stability. When I do TRX or even "light" deadlifts, my back feels better instead of worse.

I think you're on to something regarding the problem being something I'm doing, which is preventing my back from healing. As you said, the on and off nature points to that. Because I'm self employed, I go through periods of working more and less, sitting and standing at my computer more and less, and so on. I need to start paying more attention to that, and actively changing my routines to see what makes a difference.

It's not quite as bad as yesterday, but my back is pretty bad again this morning, and I did play my oud a good bit yesterday again. So I'll probably take two days off of playing and see what happens. Thanks again.
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[*] posted on 4-28-2014 at 03:31 PM


Sorry of your back pain - I know as a long time sufferer myself ... but I also used to teach yoga which if practised in a way suitable to yourself can be very helpful ... but it takes time to find out what this may be . I suspect your problem is some weakness in core stability ... you may think and be as strong as an ox but this could mask a subtle weakness. You say you feel better when you work on core strength - then it could well be that your flexibility needs a little back up from the core. The main thing is to exercise with great awareness - try some Pilates which will more than likely bring awareness to your problem quite quickly as it focuses on core stability.

Often hyperflexibility causes instability in a joint so again core strength is important. Real core strength is not about shifting large weights but about creating stable and calm flexibility - so developing breath awareness can be a very useful guide to all of your work outs (and oud posture).

BTW sitting up straight is a bit of an art, try concentrating on letting go of what is stopping you from having a more open posture and you will straighten out or rather unfold. Often people force themselves to sit bolt upright which is tense and causes more problems than they fix. Play oud with open shoulders, relaxed arms, open the hands when playing and allow the breath to be as unrestricted as possible (just be aware of little holding patterns you will have as you breath and slowly get used to letting them release ... I promise you will find them there if you tune in).

Oh and one more thing ... yes hamstrings are a common problem but more overlooked are the quadriceps and internally the psoas (which weaves through the pelvis) which can become shortened with sitting and cause the body the hunch forward from the waist. Back bends will help - always lengthening and keeping the back of the body open as the front stretches over (so as not compress the spine etc). Find a good yoga and or pilates teacher :-) they can be a goldmine!!

Good luck

Leon

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[*] posted on 4-28-2014 at 10:00 PM


Thanks Leon.

I've done various core exercises for decades, along with meditation and coordinated breathing. I think something Brian wrote has helped me to figure this out...if I'm correct. In the past the injuries I've gotten as a result of teaching martial arts were easy to pinpoint. It was easy to know exactly when they occurred and what I should and shouldn't do. With my back, it's much harder since it's used in basically every motion in every position. But I realized in the first physical therapy session which direction the movement hurt in (leaning back). And after talking to my wife and thinking about all the times it hurts, I realize that "intermittent tension" hurts it...when my back is loose then tense, loose then tense. Or, if it's loose and then very tense, quickly...as in if I begin to trip, slip on ice, etc.

Exercise, when my back gets warmed up, feels good. And I think that was masking the fact that squats (with weight) are making it worse, and not allowing it to heal. I started doing high repetitions of light squats (60k/135lbs) a couple of months ago, when it was feeling mostly better. That was around the time that I started the physical therapy. And it's also around the time that I felt it was getting better/worse, variably. When you do a squat, you have an arch to your back, and there is weight on top of that. And at the bottom of the squat, there can be a slight instability as you rise. I did lots of squats last week. Then, I worked on tapping my foot while playing the oud, and probably got carried away with "going with the beat"...intermittent tension of a sort, 60+ times per minute, for hours. So I think this combination was bad.

Anyway, hopefully I have it figured out. But I don't think it has anything to do with playing the oud.
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[*] posted on 4-29-2014 at 04:24 AM


So I brought my oud to the physical therapist today. He said that my playing almost definitely wasn't the cause of my lower back problem, but it is likely exacerbating it or slowing the healing process.

The problem is that I have been playing without a foot stool. So I've been leaning to my right, putting more weight on my right side and increasing the tension on the right side of my lower back. If I used a foot stool, this would raise my oud on the right side, and negate the need for me to lean.

He said the ideal playing position would be cross legged on the floor, because this would guarantee that my pelvis and lower back are even and balanced. I think I'm going to try playing that way, as I have done so in the past and do like it. As I think I wrote earlier in this thread, I imagine that's how the oud was played for centuries, although I could be wrong about that. It just seems perfectly designed to be played in that position.
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[*] posted on 4-29-2014 at 04:55 AM


Hi David,:wavey:
you wrote that you play around 2 hours a day. So, take care that the next problem would not be your knees:D

Do you know/seen how the Joubran-brothers play? If you can stand this kind of leg-crossing it gives you the chance to sit straight,with the back against the rest. The oud is kinda fixed than, so you can relax while playing.




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[*] posted on 4-29-2014 at 05:19 AM


Quote: Originally posted by Marcus  
Do you know/seen how the Joubran-brothers play? If you can stand this kind of leg-crossing it gives you the chance to sit straight,with the back against the rest. The oud is kinda fixed than, so you can relax while playing.


I am so so so glad that someone has said this! This is one of the ways I have been playing since I started, I thought it was only me, I didn't know about the Joubran brothers. Good to know that I'm not alone in this unusual sitting style, but I find it extremely comfortable.
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[*] posted on 4-29-2014 at 05:35 AM


Hmm...regarding the Joubran brothers...that's interesting. I've played with my RIGHT leg up, but never with my left, as they're doing it. It would seem that putting the left leg up would do the opposite, as I need my oud raised on the right side. This would raise it even more on the left side, requiring me to lean even more to the right. Maybe it's different since they're using larger/Arabic ouds. Mine is fairly small I think...a Turunz Turkish oud.

I also think that putting one leg up on top of the other while seated on a chair would put more stress on your knee joints than sitting "cross legged" on the floor.
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[*] posted on 4-29-2014 at 05:42 AM


Ah.. I didn't look at the picture properly, I lift my right leg up in that position, not the left. Still, it is very comfortable and keeps the oud parallel to the ground, probably being slightly higher that the Joubran's.
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[*] posted on 4-29-2014 at 05:44 AM


Yeah, I like that "right leg up" position. That would probably also work for me. It's what I tend to use when I sit in a chair (rarely). I've been practicing on one of two sofas, which are lower to the ground.
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[*] posted on 4-29-2014 at 06:16 AM


Have you tried an orchestra chair?
They are designed to be ergonomic for playing instruments (in particular, it keeps you pelvis higher than your knees, which is good for circulation and breathing). I don't know if they would help your back or not, but I know that playing on a sofa for longer stretches results in pain for me, since they are so low to the ground. It depends somewhat on how tall you are, I guess.




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[*] posted on 4-29-2014 at 06:19 AM


I have not tried an orchestra chair. But I think sitting cross legged on the floor will actually be ideal for me. Either that or with a foot stool. Maybe a regular chair with my right leg up would be third on the list.
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[*] posted on 4-29-2014 at 08:13 AM


A regular kitchen chair is fine but most sofas are too soft. I suggest that the sofa may be adding to the problem caused by leaning to the right. Not enough support. If you sit on the floor Be Sure to sit on a cushion or something to slightly elevate the pelvis. Otherwise you are inviting more back problems. I learned the hard way. I played (still do) raga music for many years. All the Indian string instruments have to be played sitting on the floor. Otherwise there is no balance. Every Indian string musician who sits directly on the floor gets back problems. Not some. Not most. All of them. All the ones who use a cushion do not have back problems. All the ones who formally sat on the floor and and then used a cushion recovered from their back pain. Do Not Sit Directly On The Floor unless you wish to obtain a new kind of back pain and to make the pain you already have even worse. I've been observing this for many decades.
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[*] posted on 4-29-2014 at 09:27 AM


Thank you Jody! Great advice. :)
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[*] posted on 4-29-2014 at 12:57 PM


Quote: Originally posted by DavidJE  
Thank you Jody! Great advice. :)


You're welcome. I just re-read my post and see a typo. By "formally" I meant "formerly".
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[*] posted on 4-30-2014 at 02:24 AM


I tried sitting cross legged on a cushion this morning. Unfortunately it didn't work. The problem is that if you elevate your pelvis, then your legs slant downward, which negates the benefit of the position...because the oud is too low and you have to lean forward in order to play it. If I sit cross legged without a cushion, then my legs are in the perfect place to support the oud at a playable level...with a raised leg, like the effect of a foot stool. However, I don't want to cause new injuries! So maybe the best option is to get a foot stool.

Thinking about the position Marcus and Lysander mentioned...I'm not sure this would be good for the knee and hip joint over time, due to the stress on those joints from the relatively stretched and "weighted" nature.
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