Teachers and therapists see wide range of musicians' injuries

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Teacher and professional flutist Lea Pearson of Columbus, Ohio, twice had to stop playing because of off-and-on numbness in her left hand and pain in her neck, lower back and a leg.

A student clarinetist from Carnegie Mellon University who was treated by UPMC occupational therapist Marie Pace for pain in the neck and shoulder, numbness and tingling of the fingers and a weak grip -- a condition known as thoracic outlet syndrome-- eventually gave up performing.

Saxophone player and Duquesne University professor James Houlik watched a colleague in the Pittsburgh Symphony with a hand problem "go through quite a bit to get back in the game and also had his instrument changed and adapted so the injury would not necessarily return."

The bottom line: musicians get injured a lot.

Mr. Houlik, who has devoted much time trying to help music students avoid physical problems, estimates that about 60 percent of professional musicians have injuries that cause temporary or permanent damage.

And that's excluding the health of semiprofessional or amateur musicians or others who have changed careers, said Greg Marchetti, physical therapist and associate professor in Duquesne's Rangos School of Health Sciences.

Mr. Houlik, who calls musicians "small-muscle athletes," groups the injuries together as repetitive stress injuries. Dr. Marchetti said they're also known as playing-related muscular-skeletal disorders that cover pain, weakness and tingling that interferes with playing at the usual level, some of which does not fall into the general category of repetitive stress injury.

A condition not considered repetitive stress is thoracic outlet syndrome.

According to Medline Plus, a website of the U.S. National Library of Medicine and the National Institutes of Health, thoracic outlet results when blood vessels and nerves coming from the spine or major blood vessels get compressed as they pass through a narrow space near the shoulder and armpit on their way to the arms.

Ms. Pace said players of woodwinds or brass instruments get thoracic outlet from the deep and pressured breathing they do, coupled with holding the weight of the instrument in front of the body for a prolonged time.

"It's treatable," Ms. Pace said. The tools are regular stretching and learning how to breathe from the diaphragm rather than the thorax.

Another physical problem sustained by musicians, certain athletes and typists is called focal dystonia of the hand, or writer's cramp. Although there are many forms of the neurological disorder, they all comprise repetitive, patterned and often twisting involuntary muscle contractions.

Ms. Pace treated a CMU student pianist for focal dystonia, using biofeedback. Arguably the best-known case of focal dystonia was that which began affecting American concert pianist Leon Fleischer's right hand in 1965. After years of various treatments and learning to perform with his left hand only, the Kennedy Center awardee found that occasional injections of Botox coupled with the type of massage known as Rolfing brought him enough relief that he could return to two-hand performance in 1995.

Obviously, each type of instrument leads to different injuries.

Drummers can get compressions of the ulnar nerve in the hand. Ms. Pace uses ultrasound for swelling and inflammation, runs them through stretching exercises and has them wear padded, palm protecting gloves to protect the nerve from being forcibly hit by the end of the drumstick.

Dr. Marchetti says string players "are at the highest risk level" of sustaining injuries because of the extreme positions of the arm, wrist and hand needed while playing a violin or viola. Ms. Pace says those injuries include tendinitis of flexor tendons in the string players' wrists and tennis elbow in guitar players.

Regardless the instrument, static postures and highly repetitive fast motions are predisposing factors to repetitive strain problems.

"For instance, look at the upper back and lower back in pianists," Dr. Marchetti said. They have to stabilize with no back support.

There are ways to keep these injuries from occurring or at least ending a career. Most important is acknowledging and seeking help for the pain instead of playing through it.

"Pain has to be respected," Dr. Marchetti said. "First you have to identify why it hurts. Don't accept it as part of what it takes to play. ... Look for a way to make changes at the earliest possible point."

Dr. Marchetti also said musicians must maintain their fitness aerobically and gradually improve that condition if a performance or tour is coming up. The instrument also should have the proper fit.

For example, there are some instruments, such as guitars and violins, that can be scaled down in size for a child or small adult.

Mr. Houlik teaches his Duquesne students warm-up stretches for the hands, and he does progressive relaxation exercises himself.

He also has invented an ergonomic keyboard for the saxophone that he hopes to have on the market soon. "It's not revolutionary; it's evolutionary. I've made it user-friendly." During a recent trip to Taiwan he talked with potential manufacturers.

"I'm going to market it something like 'the saxophone your hands have been waiting to hold.' I'm not risking a lot -- just my pride. And it could be the greatest legacy I leave with my instrument."

Pohla Smith: psmith@post-gazette.com or 412-263-1228.


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