Is Your Instrument Your Enemy?

Like any other physical activity, playing an instrument can take a toll on the body. Musicians face specific strains on their hands, fingers, and wrists. Many of these strains can result in injuries similar to those of professional athletes and frequent computer users. Although some strain is inevitable, education and prevention can alleviate many of the symptoms that are caused by playing an instrument.

Typical Injuries

Many of the injuries that occur to musicians involve tendons, muscles, and nerves; or a combination of all three. Repetitive motion and strain is the main cause of these pains. Diagnosing musician's injuries can range from fairly easy to difficult, because gauging the exact severity of each strain is not yet an exact science.

• Carpal Tunnel Syndrome- Affects many musicians for the same reason it affects many computer users. Pressure on the median nerve cuts off feeling to the other parts of the hand. Movement of the hand and fingers be impeded, accompanied with the sensation of numbness and sometimes tingling.The American Academy of Orthopedic Surgeons website describes Carpal Tunnel Syndrome at length.
• Tendonitis- Tendons are the cushions that join muscle to bone. Inflammation of these fibrous structures can lead to a condition known as Tendinitis. Tendinitis can occur in any joint in the body. Musicians typically experience Tendinitis in their wrists, elbows, and sometimes their shoulders. This University of Alabama at Birmingham website explains the symptoms, diagnosis, and treatments for Tendinitis.
• Bursitis- Bursa are the fluid filled sacs that accompany the tendons in cushioning muscle to bone and muscle to skin. Like tendons the bursa may become inflamed, resulting in Bursitis. Swelling, a sensation of warmth, and tenderness or pain in the joints are the main symptoms of Bursitis. The Medical Center at the University of Maryland's website summarizes Bursitis with symptoms, causes, and treatments for this illness.
• Tenosynovitis / De Quervain's Syndrome- De Quervian's Tenosynovitis Syndrome refers to extreme pain and discomfort that may occur in the protective sheath that runs over the tendons in the thumb. The pain from this injury runs from the tip of the thumb down the side of the hand to the wrist. Making a fist or even moving the wrist could result in painful discomfort. The website for Hospital for Joint Diseases at NYU further defines Tenosynovitis with the inclusion of prevention, risk factors, and other information on the syndrome.
• Tendinosis- Tendinosis is a more severe and chronic form of tendinitis. Tendinosis affects the tendons on a deeper, cellular level. Repetitive strains result in tears in the tendons, which heal at a slow rate and may never regain full strength. Information on new treatments can be found at this University of Seattle health care website.
• Thoracic Outlet Syndrome- The thoracic outlet refers to the area between the collar-bone and the rib cage. Within this area vascular, neurological, and unexplained pains and injuries may occur. Although specifics and treatment on this syndrome remain unclear, doctors agree that nerve vessels that run from the neck down to the arm become compressed, causing a mixture of numbness and pain. This Columbia University Medical Center website explains more about Thoracic Outlet Syndrome and the controversy that surrounds it.
• Myofascial Pain Syndrome- This a common ailment that affects the soft tissue by causing pain and inflammation. Trigger points in the soft tissue of muscles can extend that pain to other areas that were not originally part of strained muscle or muscle group. The Department of Pain Medicine & Palliative Care defines the syndrome and provides several treatment options to consider.
• Cubital Tunnel Syndrome- Is defined at length on the American Society for Surgery of the Hand website. Basically Cubital Tunnel Syndrome is caused when the ulner nerve that passes on the inside of the elbow is pinched by the bone that is intended to protect it. Symptoms include numbness and pain in one, or any combination of areas, between the elbow and the hand.
• Trigger Finger/Thumb- Repetitive gripping activities, such as holding a pick and strumming a guitar, can lead to a condition called Trigger Finger. The tendons around the thumb and pointer finger can become tense, creating difficultly straightening out the fingers after they become almost locked in trigger shape and form. The New England Musculoskeletal Institute's website answers many of the important questions regarding Trigger Finger and Trigger Thumb.

Prevention

Luckily many injuries connected to playing a music instrument can be lessened, or even eliminated, by preventative measures. Each instrument has a specific way it is intended to be held and played. Researching the correct posture for playing the instrument and how exactly to sit, stand, and position your limbs can be key in keeping excellent form, and preventing injury.

Just like deciding what musical instrument is right for you, picking out the actual instrument that will be used to develop this skill is just as important and personal. When choosing your instrument, keep in mind that you will be performing repetitive motions for extended periods of time. Choosing an instrument that is too heavy, too tall, or too large can produce a ripple of frustration and pain in the future. Enlisting a knowledgeable and experienced musician to accompany you in the selection of your instrument is a worthwhile investment of time and money.

Warm ups are suggested to loosen the muscles and prepare the body for continuous strain. Like an athlete, stretching can relieve tension and help create a smooth muscular flow in a practiced musician. Taking at least several minutes, before and after, practice to warm up and then cool down is recommended for optimal preparation. The exact warm ups you decide to do can be catered slightly to the instrument you play. Generally they are smooth fluid stretches of the hands, wrists, arms, and shoulders.

Exercise sessions, independent of the instrument playing practice sessions, are recommended for a musician's overall well-being and strength. Creating muscle strength, a strong solid core, proper balance, and healthy habits may result in an increased stamina which is necessary in performing and playing any musical instrument at length. T'ai Chi, Yoga, and Pilates are three exercises designed to clear the mind and improve strength, stability, and stamina. 

• T'ai Chi: The National Institute of Health's web page for the National Center for Complementary and Alternative Medicine refers to T'ai Chi as "moving medicine" and suggests its use for an overall improvement of health and well-being.
• Yoga for Musicians: This article from Berklee School of Music, in Boston, emphasizes the specific relevance of Yoga for the music world.
• Pilates: AARP answers the question of what Pilates is and emphasizes the importance of Pilates on the physical and mental health of people all ages, disabilities, and sizes. Pilates uses your own muscles as resistance to ensure that you are not supporting more weight then you can handle.

Cure

Occasionally even when proper precautions are taken injuries still may occur. Depending on your injury a general doctor may be able to provide your diagnosis and treatment. However, if the injury is severe or persistent a specialized doctor such as a neurologist or a physical therapist may be necessary. 

• Finding a Doctor for Your Specific Needs: The National Library of Medicine provides a comprehensive list of websites, phone numbers, and directories to help you find the right doctor for your needs.
• Find a Physical Therapist: The American Physical Therapist website covers a wide variety of topics regarding the nature of physical therapy, why you may need a PT, and how to find one.
• Find a Neurologist: This is a government website created and supported by the Department of Health and Human Services designed to help users locate a neurologist by the nature of the injury.

Resources

Researching your specific instrument and the proper way to use it, is one of the most basic things that can be done to avoid injury. In addition to the internet, books, CDs, and DVDs can provide valuable information on how to create and sustain the health and well-being of any musician.

• The Musician's Way: This book, by Gerald Klickstein, provides the most recent information on how to prevent music related injuries.
• The Athletic Musician: Barbara Paull and Christine Harrison bring together unique ways to prevent and manage a musician’s injuries, as well as scientific breakdowns of these injuries.
• You are Your Instrument: This book, By Julie Lyonn Lieberman, discusses every way to play music without pain. This book includes details on how to help a musician's performance and confidence.
• What Every Musician Needs to Know About the Body: This book was created for beginners to emphasis the importance of promoting and maintaining musicians' wellness.
• Indirect Procedures: Pedro de Alcantara discusses ways musicians can improve and maintain their health through the years.
• Musician's Yoga: A book, by Mia Olson, is about how any musician can improve their musical prowess by including yoga into their daily routine.
• Muscle Management for Musicians: Elizabeth Andrews uses human anatomy to explain how a musician is affected by playing their instrument. She outlines how musicians can improve their performance by having healthy habits.
• Fit as a Fiddle: This book, By William Dawson, discusses important topics regarding the health of instrumentalists, including illnesses these musicians may develop.
• Performance without Pain: An informative guide for anyone with pain. This book provides detailed steps to understand and promote a healthy diet.
• Playing (Less) Hurt: Janet Horvath, with insights from doctors and musicians, writes about techniques musicians can use to play with ease, throughout practice and concerts.
• Winsor Pilates DVD: Pilates can improve balance, stamina, and give the entire body an excellent stretch. Musicians can benefit from all that Pilates has to offer.
• What Exactly is T'ai Chi?: Benjamin Pang Jeng Lo's 4 disc DVD that goes into the specifics on what exactly T'ai Chi is, explains its origin and meaning, and how to use it.
• T'ai Chi CDs: You can purchase 4 different T'ai Chi CDs on Good Karma Publishing's website 
• The Indigo Girls Workout Video: Famous musicians, The Indigo Girls, created this 70 minute workout video in 2002. This DVD includes warm ups, cardio exercises, strength training, and a cool down.
• How To Practice: Drummers' Warm Up DVD: This DVD is perfect for drummers who wish to take preventative measures to avoid injury while playing their drums.