|Music transforms life. Whether it is classical, jazz, rock, pop, country, the music we hear all around us is played by musicians who will have spent many years perfecting their instrument to get to a level of proficiency where they can play to public acclaim.|
Perhaps surprisingly, musicians can experience work-related pain, very similar in origin and symptoms to PC or keyboard users. The principle of onset is similar: repetition. In the case of PC based workers, RSI or Repetitive Strain Injury was the term used for a set of symptoms that included a particular type of burning pain in the arm associated with excessive keyboarding. The term RSI has now been replaced by a slightly broader but more ergonomically accurate phrase Work Related Upper Limb Disorder (WRULD). This term that is applicable to the musician’s plight.
Research shows that players of wind instruments and violin or fiddle generate more injuries than drummers, pianists, or others. When you think of holding a violin or flute or clarinet for hours and hours on end practicing to become a fulltime musician, you can imagine just how much finger work goes on to generate each note, each sound. Though the hands are doing the work, it is dependant on the strength of the arms, shoulders and neck to support the hands and the instrument.
In many cases, in questioning a musician in detail about when the pain came on, it will emerge that the symptoms became noticeable after an intense bout of practising, maybe getting a piece ready for performance. In this case the musician has put perhaps hundreds of hours of practice to perfect the piece, endlessly rehearsing small components of the piece to get it finger perfect.
If the music is particularly new or technically challenging practice will involve deep and sustained concentration. In the effort of focussing and working on the technical bit, ideal body posture is invariably forgotten. The head may poke forward peering intently on the music on the page, or the instrument is gripped slightly tighter than necessary in an effort to master the notes. Sometimes the furniture in the practice room is also less than ideal, or the room is cold.
Any one or all of these scenarios put the body under pressure. Just like an athlete training in poor training conditions or the office worker in a less than ideal work environment, the body will begin to suffer.
If intense practice in poor conditions is kept up, the body responds by giving out pain signals as a warning sign that something is amiss. What is unusual in WRULD or RSI type presentations is that the pain may be vague and spread over a large area, especially if left untreated over a period of time.
When a musician presents with arm or hand pain, assessment needs to be wholistic: starting at the spine and working out along the limb, sometimes including the whole body, if posture dictates it. In the spine, some local joint stiffness may have developed from holding the instrument too long or at a slightly less than perfect angle. Manual therapy is used to address joint stiffness.
The musician will have been taught exactly how to hold their instrument at the beginning, but with much repetition, develops their own postural ‘kinks’. This may add to their performance ‘look’ but invariably places an extra postural burden on the body. The odd thing about bad postural habits is that it feels comfortable or natural to the individual even though it is functionally incorrect. Identifying and correcting poor posture and bad technique is essential in assisting the musician to play without pain or causing further strain
We ask the musician to bring their instrument when visiting the clinic (we have had cellos, tubas and even Irish harps in our practice on occasion). Even without knowing the ins and outs of every musical instrument, the special training of a physiotherapist is in assessing movement patterns. The trained and observant eye will pick up incorrect postural habits or repeated movement faults.
Postural retraining involves explanations, hands, eyes and a mirror. The physiotherapist guides movement retraining with their hands and uses visual clues from getting the patient to watch their technique in a mirror. This helps to wipe out the bad posture by replacing it with a new more ideal version. Being body posture aware by using mirrors when playing in a rehearsal room is the surest way for the musician to bring about positive change.
A general finding in assessment is that some muscles in the trunk, neck and arms have become short and over strong, typically around the front of the neck, upper chest and around the wrist while others have become weak from the adopted faulty posture. It is almost invariable to find weakness of muscles that clamp the shoulder blades onto the ribcage. This is easy to spot; the shoulder blades stick out more than they should while the musician is playing their instrument and is a sure sign that muscle are not working in correct co-ordination.
Specific exercises are needed to strengthen weak these and other muscles and stretch tight ones. Progression involves restoring muscle co-ordination so that the retrained muscles work coherently together.
Finally, one component of musician’s arm pain is nerve pain. This part of the clinical picture can be challenging to treat.
Musicians, like athletes, dancers and other performance artists are fascinating and very rewarding to treat. They often present with complex presentations which can threaten their livelihood and general health. Solving their pain and movement issues can be challenging but is all worthwhile in the end.