Musculoskeletal Injuries In Musicians 2008

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Musculoskeletal Injuries In Musicians 2008

  1. 1. Musculoskeletal Injuries in MusiciansEvaluation & Treatment<br />Shannon Marie Scott, OTR/L<br />
  2. 2. Injuries in Musicians<br />Musicians are prone to musculoskeletal injuries (MSI)<br />Musicians are notoriously hard to persuade to reduce or stop their playing<br />Instructors or parents may tell a student to ignore the pain and accuse them of trying to avoid practice<br />May assume condition is normal and find ways to mask a developing injury<br />Belief that “the show must go on”<br />
  3. 3. Types of Injuries<br />Most common include:<br />Carpal tunnel syndrome<br />Tendonitis<br />Bursitis<br />Tenosynovitis<br />DeQuervain’s Syndrome<br />Tendinosis<br />Thoracic Outlet Syndrome<br />Myofascial Pain Syndrome<br />Cubital Tunnel Syndrome<br />Trigger Finger/Thumb<br />Focal Dystonia<br />Strains<br />(Similar to that of computer overuse)<br />
  4. 4. Why are Musicians Prone to MSI?<br />Long hours of practice, rehearsals, performances<br />Overuse<br />Incorrect postures<br />Non-ergonomic technique, faulty technique<br />Excessive force<br />Stress<br />Insufficient rest periods<br />Avoidance of breaks during practice<br />Lack of education<br />Many musicians develop these injuries because their bodies were not conditioned enough to put in the many hours of strenuous muscular activity<br />
  5. 5. Symptoms<br />Approximately half of professional musicians and music students experience symptoms<br />Pain<br />Weakness<br />Numbness<br />Tingling<br />Stiffness (reduced ROM)<br />Loss of muscular control<br />
  6. 6. Other Warning Signs<br />Difficulty grasping items<br />Weakness of the hands<br />Increased feeling of clumsiness<br />Constantly sore forearm muscles<br />Coldness in the fingers while playing<br />Hands turn blue or flush erratically<br />Restricted motion<br />
  7. 7. Pain<br />Pain is often first and most prominent symptom<br />Result of inappropriate repertoire or performance habits<br />Secondary to illness or trauma<br />Myofascial pain commonly occurs in neck and shoulder girdle, as well as forearm flexors and extensors<br />Musicians often have to make frequent, rapid ballistic movements or perform wide-hand techniques such as chords<br />Intensity of practice often correlates with prevalence of symptoms<br />Performers often attempt to play through the pain<br />Playing through the pain results in incoordination due to antalgic inhibition of the find hand movements<br />
  8. 8. Numbness<br />Usually along ulnar border of the forearm and hand<br />Symptomatic thoracic outlet syndrome is often accompanied by myofascial neck and shoulder girdle postural deficits<br />
  9. 9. Incoordination<br />Often directly associated with numbness and pain<br />Some experience incoordination as a focal dystonia or occupational cramp<br />
  10. 10. Level of Injury<br />Level I<br />Pain occurs after playing, but are able to perform normally<br />Level II<br />Pain occurs during playing, but are not restricted in performing<br />Level III<br />Pain occurs during playing and begins to affect some aspects of daily life, must alter technique or reduce the duration of activity<br />Level IV<br />Pain occurs as soon as you attempt to play and is too severe to continue, many aspects of daily life are affected<br />Level V<br />Pain is continuous during all ADLs and you are unable to participate in playing<br />
  11. 11. Evaluation<br />Observe the performance of the activity<br />Look at posture<br />Look at technique<br />Assess the playing environment if possible<br />Evaluate other activities<br />May be caused by other things the musician is doing frequently<br />Computer use<br />Child care<br />Hobbies<br />Sports<br />Determine if the size, weight, or shape of the instrument is appropriate for the individual<br />
  12. 12. String Instruments<br />String players are most prone to injuries in the back, shoulders, and neck<br />Complain of muscle stiffness, pain, soreness, tension<br />Complain of numbness of fingers, hand, wrist, neck, jaw, back, and shoulders<br />
  13. 13. Case Study – Violinist with Shoulder Pain<br />22 y.o. violinist with hx of persistent, aching, bilateral shoulder pain that occurred during and after playing<br />Noted increased tension in head and neck while playing<br />Pain during resisted abduction and external rotation with painful arc during active abduction<br />Pain at outer range of passive internal and external rotation<br />Used increased scapular movement to facilitate internal rotation<br />Diagnosed with rotator cuff tendonitis<br />Treatment<br />Decreased length of performance, increased rest time<br />Did not require change in position or technique<br />Prolonged passive stretching at 30-second intervals and use of ultrasound for deep-heating<br />Conditioning program to improve shoulder girdle endurance with progressive resisted exercises<br />
  14. 14. Case Study – Cellist with Fibromyalgia<br />Middle-aged cellist with increased pain<br />Pain in neck, back, and all four extremities<br />Started as aching and later became sharp with increased movement, especially when playing cello<br />Myofascial tenderness throughout infraspinatous and infrascapular areas, trapezius, acromial process, extensor and flexor surfaces of the forearms, low back<br />Repetetive use of forearm flexors increased pain<br />Treatment<br />Recommended aerobic program, suggested warm-up exercises and shorter practice sessions<br />Performance improved with better sleep and stretching program<br />Modified playing technique, engaged in relaxation exercises and more active exercise program<br />
  15. 15. Case Study – Guitarist with Forearm Pain<br />Guitarist with bilateral forearm pain during and after playing<br />Pain extended into each hand mainly along extensor surface but also on flexor surface<br />Treatment<br />Used videotapes to demonstrate to the player his poor ergonomic position of the guitar<br />Adopted a more upright position of playing and although it felt “foreign” to him, he was able to play for 30 minutes without pain<br />Treatment focused on improving range of motion and strength<br />
  16. 16. Wind Instruments<br />Wind players are prone to ear, nose, throat, mouth, lip injuries<br />Also prone to neck, shoulder, and arm injuries<br />
  17. 17. Case Study – Flautist with Shoulder Girdle Pain<br />20 y.o. flautist with shoulder girdle pain and sensory loss<br />Parasthesia and aching in left hand<br />Symptoms began after MVA which caused a flexion-extension injury of cervical spine<br />Pain and numbness along medial aspect of left arm from mid-forearm radiated to 4th and 5th digits<br />Decreased hand coordination and limited time she was able to hold the flute upright<br />Decreased sensation to touch and pinprick over dorsal and volar surfaces of 4th and 5th digits and along ulnar border of forearm<br />Treatment<br />Conditioning program for cervical spine and shoulders to improve posture<br />Modified practice time to play within tolerance of symptoms rather than through the pain<br />Symptoms worsened when she neglected to perform exercises or performed any type of unaccustomed activity<br />
  18. 18. Percussion<br />Percussionists often complain of back, shoulder, neck, hand, wrist, fingers, and arm pain and tension<br />Some of the most common injuries of percussionists are tendonitis and carpal tunnel syndrome<br />Be aware of awkward postures and positions while percussionist is playing<br />
  19. 19. Keyboard and Piano<br />Hand injuries as a result of fast movements and wide-hand movements and inappropriate warm-up techniques<br />Postural concerns with sitting position at the piano<br />
  20. 20. Case Study – Organist with Numbness<br />Organist with numbness and parasthesia in 4th and 5th digits of right hand<br />Difficulty sensing keys with affected digits<br />Decreased sensation to touch and pinprick on palmar surface of 5th and 4th digits<br />Positive tinel’s sign over the right cubital tunnel<br />Treatment<br />Suggested the player avoid pressure on the cubital tunnel and use an elbow pad<br />
  21. 21. Treatment Basics<br />Appropriate warm-up and stretching of affected area<br />Performance of easy pieces and later progression to more technically difficult pieces<br />Frequent breaks to allow recovery during play<br />Review playing technique and modify if necessary<br />Review and modify the instrument if necessary<br />
  22. 22. Conservative Treatment<br />Permits player to continue playing, but modifications are made<br />Practice segments are reduced with increased breaks<br />Control of posture and body awareness improved<br />Alexander Technique, Yoga<br />Technique of the player is reviewed and repertoire causing pain is stopped<br />
  23. 23. Radical Rest Treatment<br />Total avoidance of pain-inducing activities<br />Essential to keep joints moving through full range of motion to avoid secondary changes, but not against resistance or load<br />Begin with a very small amount of hand use and increasing incrementally<br />
  24. 24. Posture and Conditioning<br />Musicians often fail to build strength and endurance through other forms of activity<br />Exercise program should include aerobic activities, progressive resisted exercises, and postural training<br />Stretching scalenes by lateral neck flexion<br />Chin retraction and neck rotation movements sustained at end range<br />Stretching pectoral muscles<br />
  25. 25. Adjunct Treatment<br />Ice, e-stim, acupuncture for chronic pain control<br />Localized symptoms – ultrasound<br />Basic goal – to return to the highest level of movement, strength, endurance, sensation, coordination<br />
  26. 26. Instrument Modification<br />Adjust chin rest of violin or viola<br />Changing supporting pins of cello to more vertical position<br />Fit flute with thumb support<br />Etc.<br />
  27. 27. Prevention<br />Don’t skip warm-up exercises<br />Attend to good posture<br />Be aware of good technique while playing<br />Listen to your body<br />Take breaks while playing<br />
  28. 28. Exercise Basics for Musicians<br />Commit to 3 days a week<br />Involve both weight training and aerobic training<br />Musicians should concentrate on high repetition, low to medium weight exercises (15 repetitions)<br />Drummers need arm and leg strength<br />Cellists need overall upper body strength<br />Routine should be tailored to the type of instrument<br />Focus on developing muscles for posture and core control<br />
  29. 29. Education<br />Educating musicians is essential for preventing recurrence of symptoms<br />Include understanding of the ergonomics of performance<br />Play without causing symptoms and play regularly to maintain endurance, appropriate warm-up periods, proper instrument maintenance, maintaining general physical fitness<br />Start by educating students when they are just beginning to develop good playing habits and techniques<br />Educate music majors in colleges<br />
  30. 30. “Top-Ten”<br />1. listen to your body<br />2. take more breaks (5-10 minutes every 45 minutes)<br />3. avoid sudden increase in playing time<br />4. be careful when changing instruments<br />5. be aware of playing environment<br />6. prepare body before playing (stretch, warm-up)<br />7. watch your posture (try videotaping self)<br />8. become “one” with the music (let your body move while you play, don’t stay rigid)<br />9. drink plenty of water<br />10. eat a healthy diet<br />

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