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Injuries related to music performance
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MusiciansMusicians andandMusculoskeletal injuriesMusculoskeletal injuries
Cynthia C. CarsleyCynthia C. CarsleyB. Sc. B. Sc. PhysiotherapyPhysiotherapy
M. Sc.(A) M. Sc.(A) OccupationalOccupational HealthHealth
MusiciansMusicians andand MSIMSI
�� OverviewOverview ofof healthhealth issuesissues�� Musculoskeletal injuriesMusculoskeletal injuries
�� AnatomyAnatomy�� SpecificSpecific disordersdisorders�� RiskRisk factorsfactors�� PreventionPrevention�� TreatmentTreatment
OverviewOverview ofof healthhealth issuesissues�� MusiciansMusicians’’ websiteswebsites
�� Part 1: Introduction and Background.Part 1: Introduction and Background. Preventing Preventing Musculoskeletal Injury (MSI) For Musicians And Dancers:Musculoskeletal Injury (MSI) For Musicians And Dancers:A Resource GuideA Resource Guide
http://www.shape.bc.ca/resources/pdf/part1.pdfhttp://www.shape.bc.ca/resources/pdf/part1.pdf�� Part 2: Musicians.Part 2: Musicians. Preventing Musculoskeletal Injury (MSI) Preventing Musculoskeletal Injury (MSI)
For Musicians And Dancers: A Resource Guide For Musicians And Dancers: A Resource Guide http://www.shape.bc.ca/resources/pdf/part2.pdfhttp://www.shape.bc.ca/resources/pdf/part2.pdf
�� Musicians and injuries. Engineering Electronics Shop Musicians and injuries. Engineering Electronics Shop http://http://eeshop.unl.edu/music.htmleeshop.unl.edu/music.html
�� DaumDaum, M.C. Musculoskeletal problems in musicians. , M.C. Musculoskeletal problems in musicians. Center for Safety in the Arts Center for Safety in the Arts
http://http://www.sierranevada.edu/life/safety/musicsaf.htmwww.sierranevada.edu/life/safety/musicsaf.htm
MusiciansMusicians andand MSIMSI
�� OverviewOverview ofof healthhealth issuesissues�� EarEar, , nosenose & & throatthroat�� HearingHearing lossloss�� Skin Skin disordersdisorders�� Dental Dental problemsproblems�� PsychologicalPsychological aspectsaspects
OverviewOverview ofof healthhealth issuesissues
�� EarEar, , nosenose andand throatthroat�� Quick Quick diagnosisdiagnosis�� Quick interventionQuick intervention
OverviewOverview ofof healthhealth issuesissues�� HearingHearing lossloss* *
�� 30% rock (pop) 30% rock (pop) musiciansmusicians�� 50% 50% classicalclassical musiciansmusicians�� SolutionsSolutions
�� EnvironmentalEnvironmental techniques techniques �� EarplugsEarplugs, monitors etc., monitors etc.
�� TinnitusTinnitus�� Pitch perception Pitch perception
problemsproblems
* * ChasinChasin, M. , M. MusiciansMusicians & & thethe PreventionPrevention ofof HearingHearing LossLoss. . HearingHearing ReviewReview 1999. 1999. SeeSee www. www. musiciansclinics.commusiciansclinics.com
OverviewOverview ofof healthhealth issuesissues
�� Skin Skin problemsproblems**�� VaryVary widelywidely�� Point Point ofof contactcontact�� BruisesBruises, , callusescalluses, , cutscuts, ,
abrasions, abrasions, ulcersulcers, , eczemaeczema((bowbow resinresin))
�� 62% 62% violinistsviolinists & & violistsviolistsunderunder chinchin ((leftleft))
�� 32% string 32% string playersplayers�� 27% 27% windwind & & brassbrass
* Ostwald, P.F. et * Ostwald, P.F. et alal, , PerformingPerforming arts arts medicinemedicine. West J . West J MedMed 1994.1994.
OverviewOverview ofof healthhealth issuesissues
�� Dental Dental problemsproblems**
�� PeriodontalPeriodontal diseasedisease�� MalocclusionMalocclusion�� LooseLoose teethteeth
Brasses & Brasses & woodwindswoodwinds
*Ostwald, P.F. et *Ostwald, P.F. et alal, , PerformingPerforming arts arts medicinemedicine. . West J West J MedMed 1994.1994.
OverviewOverview ofof healthhealth issuesissues
�� PsychologicalPsychological**�� Social pressureSocial pressure�� FatigueFatigue�� IncreasedIncreased adrenalineadrenaline�� AnxietyAnxiety�� FinancialFinancial instabilityinstability
* Ostwald, P.F. et * Ostwald, P.F. et alal, , PerformingPerforming arts arts medicinemedicine. West J . West J MedMed 1994.1994.
MusiciansMusicians andand MSIMSI
""SomeSome fingersfingers, , nono doubtdoubtbecause because ofof too much too much writingwriting andand playingplaying in in earlyearly yearsyears, have , have becomebecomequitequite weakweak, , soso I I cancanhardlyhardly use use themthem..""
Robert Schumann (1810 -1856)
Schumann (1839)
MusiciansMusicians andand MSIMSI
Musculoskeletal injuriesMusculoskeletal injuries�� Muscle, Muscle, bonebone, tendon, joints, ligaments, nerves, , tendon, joints, ligaments, nerves,
bloodblood vesselsvessels andand relatedrelated soft tissuessoft tissues�� CatchCatch--allall termsterms (RSI, (RSI, CTDsCTDs, , WRMSDsWRMSDs))�� 50% 50% ofof allall musiciansmusicians**�� Can Can limitlimit, , interruptinterrupt or or endend a a careercareer
* * Part 2: Musicians.Part 2: Musicians. Preventing Musculoskeletal Injury (MSI) For Musicians And DancePreventing Musculoskeletal Injury (MSI) For Musicians And Dancers: A Resource Guiders: A Resource Guide
MusiciansMusicians andand MSIMSI
�� OverviewOverview ofof healthhealth issuesissues�� Musculoskeletal injuriesMusculoskeletal injuries
�� AnatomyAnatomy�� SpecificSpecific disordersdisorders�� RiskRisk factorsfactors�� PreventionPrevention�� TreatmentTreatment
AnatomyAnatomy
�� MuscleMuscle�� ConnectedConnected to to bonesbones by by
tendons (tendons (atat eithereither endend))�� ElasticElastic�� ProvidesProvides movementmovement andand
stabilitystability
�� FasciaFascia�� SheetsSheets ofof fibrousfibrous tissue tissue
betweenbetween layerslayers ofof musclesmuscles�� Source Source ofof pain pain andand
tightnesstightness
AnatomyAnatomy
�� TendonTendon�� RopeRope--likelike structure structure mademade
ofof strongstrong smoothsmooth fibersfibers�� NonNon--elasticelastic�� TearsTears if if overstretchedoverstretched�� DuringDuring movementmovement, ,
slidesslides in in lubricatedlubricatedtendon tendon sheathsheath
AnatomyAnatomy
�� JointJoint�� Area Area ofof union union betweenbetween 2 2
or more or more bonesbones�� LinedLined withwith synovial synovial
membranemembrane�� Membrane Membrane producesproduces
lubricantlubricant calledcalled synovial synovial fluidfluid
�� Synovial Synovial fluidfluid allowsallowssmoothsmooth movementmovement
AnatomyAnatomy
�� BursaeBursae�� SacSac--likelike cavitiescavities filledfilled withwith
synovial synovial fluidfluid�� FoundFound aroundaround jointsjoints�� Friction Friction maymay developdevelop
AnatomyAnatomy
�� CartilageCartilage�� CoversCovers endsends ofof bonesbones for for
smoothsmooth joint joint movementmovement
AnatomyAnatomy
�� NervesNerves�� CordlikeCordlike structures structures
transmit transmit electricalelectricalimpulses to impulses to andand fromfrombody parts body parts theythey controlcontrol
AnatomyAnatomy
�� PeripheralPeripheral nervesnerves�� TravelTravel fromfrom cranialcranial nerves in nerves in brainbrain or spinal or spinal
cordcord to to outerouter regionsregions ofof bodybody
�� MotorMotor nervesnerves�� SendSend signalssignals to musclesto muscles
�� SensorySensory nervesnerves�� Transmit pain, Transmit pain, temperaturetemperature, position, , position, andand
pressure in skin, muscles & joints to pressure in skin, muscles & joints to thethe brainbrain
AnatomyAnatomy
�� IntervertebralIntervertebral disc disc and menisciand menisci�� FibrousFibrous cartilagecartilage�� Provide extra cushioningProvide extra cushioning
MusiciansMusicians andand MSIMSI
�� OverviewOverview ofof healthhealth issuesissues�� Musculoskeletal injuriesMusculoskeletal injuries
�� AnatomyAnatomy�� SpecificSpecific disordersdisorders�� RiskRisk factorsfactors�� PreventionPrevention�� TreatmentTreatment
Musculoskeletal Musculoskeletal disordersdisorders
�� SignsSigns andand symptomssymptoms�� SwellingSwelling�� RednessRedness�� DifficultyDifficulty movingmoving jointjoint�� LossLoss ofof motormotor controlcontrol�� NumbnessNumbness�� TinglingTingling�� PainPain
Musculoskeletal Musculoskeletal disordersdisorders
�� PainPain�� Unique for each individualUnique for each individual�� High threshold in performersHigh threshold in performers�� Performers normalize painPerformers normalize pain�� No pain, no performanceNo pain, no performance�� Fear label Fear label ‘‘musician with injurymusician with injury’’�� Lack of resources to subsidize and prevent early Lack of resources to subsidize and prevent early
treatment treatment
Musculoskeletal Musculoskeletal disordersdisorders
�� PainPain�� DefensiveDefensive mechanismmechanism intendedintended to to protectprotect�� May May notnot appearappear duringduring activityactivity responsibleresponsible�� May May occuroccur duringduring sleepsleep�� May May appearappear suddenlysuddenly or or graduallygradually overover monthsmonths�� PayPay attention to attention to whenwhen? ? howhow long?long?
influence on influence on abilityability to to performperform ADLsADLs? ?
Progression of MSI signs & symptoms in performersProgression of MSI signs & symptoms in performers(SHAPE(SHAPE--Preventing MSI for Musicians and DancersPreventing MSI for Musicians and Dancers--A Resource Guide, 2002)A Resource Guide, 2002)
Pain occursPain occurs after after class, practice, rehearsal or performance, class, practice, rehearsal or performance, but the musician but the musician performs normallyperforms normally
Pain occursPain occurs during during class, practice, rehearsal or performance, class, practice, rehearsal or performance, but the musician is but the musician is not restrictednot restricted in performingin performing
Pain occurs Pain occurs during during class, practice, rehearsal or performance, class, practice, rehearsal or performance, and begins to and begins to affect affect some aspects of some aspects of daily life. daily life. Musician Musician alters technique, alters technique, ↓↓ duration.duration.
Pain occurs Pain occurs as soon as the musician participatesas soon as the musician participates in class, practice, rehearsal, in class, practice, rehearsal, or performance , and is or performance , and is too severe to continuetoo severe to continue. Many aspects of daily life are affected.. Many aspects of daily life are affected.
Pain is continuous during all activities of daily life, and the Pain is continuous during all activities of daily life, and the musician is unable musician is unable to participate in class, practice, rehearsal,to participate in class, practice, rehearsal, or performance.or performance.
Level ILevel I
Level IILevel II
Level IIILevel III
Level IVLevel IV
Level VLevel V
MSI MSI specificspecific disordersdisorders
�� Tendon & muscle Tendon & muscle disordersdisorders�� TendinitisTendinitis : inflammation due to irritation : inflammation due to irritation ofof thethe
tendon tendon andand or or sheathsheath fromfrom excessexcess tension tension andandfriction friction fromfrom repeatedrepeated movementsmovements..
�� Due to Due to awkwardawkward postures postures thatthat stretch stretch andand bendbendtendons tendons aroundaround jointsjoints
�� Excessive tension & impact Excessive tension & impact →→ tearstears →→ scarscar tissue tissue →→ thickenedthickened, , bumpybumpy & & irregularirregular tendon & tendon & sheathsheath
MSI MSI specificspecific disordersdisorders
�� Focal Focal dystoniadystonia�� MalfunctionMalfunction ofof muscle muscle atat a a specificspecific location location resultingresulting in:in:
�� CrampingCramping�� InvoluntaryInvoluntary flexingflexing or or straighteningstraightening ofof thethe jointjoint�� SenseSense ofof fatiguefatigue�� LossLoss ofof coordinationcoordination�� May or May or maymay notnot bebe painfulpainful�� ReferredReferred pain pain withwith crampingcramping & & spasmspasm�� InterferesInterferes withwith abilityability to to playplay
MSI MSI specificspecific disordersdisorders
�� Focal Focal dystoniadystonia typicallytypically affects :affects :�� Hands & Hands & fingersfingers ofof string string andand keyboardkeyboard playersplayers�� DrummersDrummers’’ feetfeet�� VocalistsVocalists’’ vocal vocal cordscords�� Embouchure Embouchure ofof brassbrass playersplayers((SternbachSternbach 1994)1994)
MSI MSI specificspecific disordersdisordersHand, Hand, wristwrist & & forarmforarm
�� KeyboardKeyboard & & guitarguitar playersplayers�� StrainingStraining smallsmall hand muscleshand muscles�� LateralLateral fingerfinger movementmovement & & fingerfinger spreadspread�� Stress on Stress on fingerfinger flexorsflexors atat large large MCPsMCPs ((knucklesknuckles))�� LoudLoud repeatedrepeated octaves or octaves or chordschords((ChongChong et et alal 1989)1989)
MSI MSI specificspecific disordersdisordersHand, Hand, wristwrist & & forarmforarm
�� String String playersplayers�� LeftLeft wristwrist flexorsflexors
(pressure on strings)(pressure on strings)�� ExtensorsExtensors ofof rightright wristwrist
whilewhile bowingbowing�� Small Small rapidrapid bowbow
movementsmovements�� SustainedSustained rapidrapid tremelotremelo
causes causes ↑↑ demandsdemands on on flexorsflexors & & extensorsextensors
MSI MSI specificspecific disordersdisordersHand, Hand, wristwrist & & forarmforarm
�� Certain Certain windwindinstruments:instruments:�� oboeoboe�� frenchfrench hornhorn�� fluteflute
requirerequire sustainedsustained extension extension to to holdhold instrument instrument whilewhileallowingallowing fingersfingers to to curlcurl intointoposition for position for fingeringfingering..
MSI MSI specificspecific disordersdisordersHand, Hand, wristwrist & & forarmforarm
�� De QuervainDe Quervain’’s s tenosynovitistenosynovitis�� Pain in tendons Pain in tendons atat base base ofof thumbthumb & & thumbthumb sideside ofof
ofof forarmforarm�� PainfulPainful to to movemove thumbthumb awayaway fromfrom handhand�� PainfulPainful firmfirm grip or grip or twistingtwisting motionmotion
De QuervainDe Quervain’’s s tendinitistendinitis
•• OboeOboe playersplayers•• ClarinetClarinet, , fluteflute playersplayers use use
thumbthumb extensorsextensors to to support instrumentsupport instrument
•• Drummers Drummers extremeextremeflexion & flexion & laterallateral motion motion ofof wristwrist withwith rapidrapiddecelerationdeceleration atat impactimpact
•• KeyboardKeyboard & & thumbthumbunderunder ascensionascension
((ChongChong et et alal 1989; 1989; ZazaZaza 19981998))
MSI MSI specificspecific disordersdisordersElbowElbow
�� LateralLateral epicondylitis epicondylitis (tennis (tennis elbowelbow))�� EpicondyleEpicondyle atat elbowelbow isis
anchoranchor point for point for severalseveralmusclesmuscles
�� Pain Pain atat elbowelbow, , forarmforarm or or wristwrist
MSI MSI specificspecific disordersdisordersElbowElbow
�� MedialMedial epicondylitisepicondylitis((golfergolfer’’ss elbowelbow))�� MusiciansMusicians’’ complexcomplex posturespostures
�� forarmforarm rotationrotation
�� bendingbending wristwrist withwith independantindependantfingerfinger movementmovement
�� keyboardkeyboard, percussion, , percussion, clarinetclarinet, , harpharp, , oboeoboe, trombone, trombone
MSI MSI specificspecific disordersdisordersShoulderShoulder
�� RotatorRotator cuffcuff tendinitistendinitis�� Tendons Tendons ofof severalseveral muscles muscles thatthat stabilizestabilize armarm atat thethe shouldershoulder�� Due to Due to raisedraised shouldershoulder outwardoutward or or forwardforward
�� ViolinViolin, viola,, viola,cellocello�� String String bassbass�� BassoonBassoon((ChongChong et et alal 1989, 1989, ZazaZaza 1998)1998)
�� Pain: Pain: �� usuallyusually atat top or front top or front ofof shouldershoulder�� atat outerouter part part ofof armarm�� atat nightnight
MSI MSI specificspecific disordersdisordersBack & neckBack & neck
�� LowLow backback pain (LBP)pain (LBP)�� ProlongedProlonged sittingsitting & & restrictedrestricted
posture posture (Fry 1986; (Fry 1986; ChongChong 1989)1989)
�� FlattensFlattens curvecurve in in spinespine
�� ↑↑ intravertebralintravertebral discdisc (IVD) (IVD) pressure pressure →→ bulgingbulging →→herniationherniation
�� ↑↑ tension on tension on posteriorposteriorligaments & ligaments & smallsmall muscles muscles →→
�� local local swellingswelling�� muscle muscle spasmspasm�� nerve compression nerve compression
MSI MSI specificspecific disordersdisordersUpperUpper backback & neck& neck
�� OftenOften due to:due to:�� Postures Postures requiredrequired to support instrumentto support instrument�� StrengthStrength requiredrequired to support or to support or playplay largerlarger
instruments (double instruments (double bassbass, , bassoonbassoon))�� StaticStatic headhead position position →→ face & neck pain face & neck pain
(viola & (viola & violinviolin))�� TurningTurning headhead to to oneone sideside ((fluteflute & & harpharp))�� TiltingTilting headhead downwarddownward (sax & (sax & keyboardkeyboard))�� MethodsMethods ofof transportingtransporting & & carryingcarrying
MSI MSI specificspecific disordersdisordersHead & faceHead & face
�� OrbicularisOrbicularis orisoris�� StrainingStraining ofof muscles muscles thatthat control control mouthmouth & & lipslips
((vocalistsvocalists & & hornhorn playersplayers))�� TemporomandibularTemporomandibular joint (TMJ)joint (TMJ)
�� windwind instruments & instruments & instrumentsinstruments thatthat requirerequire carefulcareful andandsustainedsustained jawjaw positioningpositioning(viola, (viola, violinviolin, sax, , sax, clarinetclarinet, , frenchfrench hornhorn))
�� Face & neck pain & Face & neck pain & headachesheadaches�� OftenOften relatedrelated to to psychologicalpsychological stress stress andand teethteeth alignmentalignment�� Excessive muscle tension (Excessive muscle tension (teethteeth clenchingclenching) ) �� DegradationDegradation ofof thethe jointjoint
MSI MSI specificspecific disordersdisordersNerve compressionNerve compression
�� CarpalCarpal tunnel syndrometunnel syndrome�� NumbnessNumbness, , tinglingtingling & or pain in & or pain in
thumbthumb, index, , index, middlemiddle fingerfinger�� Due to compression Due to compression ofof nerves, nerves, bloodblood
vesselsvessels, tendons, tendons�� Due to Due to activitiesactivities requiringrequiring repetitiverepetitive
sustainedsustained wristwrist flexion flexion withwith alotalot ofoffingerfinger movementmovement
�� LeftLeft hand hand ofof violinistsviolinists, , violistsviolists, , guitarguitarplayersplayers (12 or 13th position (12 or 13th position tootoo long)long)((SternbachSternbach 1991)1991)
MSI MSI specificspecific disordersdisordersNerve compressionNerve compression
�� Cubital tunnel syndromeCubital tunnel syndrome�� Compression Compression ofof nerve nerve atat ulnarulnar sideside
ofof elbowelbow�� NumbnessNumbness, , tinglingtingling pain or pain or lossloss ofof
coordination in 4th & 5th coordination in 4th & 5th fingersfingers..�� Pain Pain atat elbowelbow�� Due to postures Due to postures requiringrequiring flexion flexion atat
elbowelbow & & wristwrist withwith rotation rotation ofof palm palm upwardupward
�� LeftLeft hand hand ofof violinistsviolinists, , violistsviolists, , guitarguitar playersplayers ((ChongChong 1989)1989)
MSI MSI specificspecific disordersdisordersThoracicThoracic outletoutlet syndromesyndrome
�� SymptomsSymptoms similarsimilar to CTS, to CTS, CuTSCuTS�� Compression Compression ofof group group ofof nerves nerves
((andand or or bloodblood vesselsvessels))travelling travelling towardtoward thethe armarm betweenbetweenthethe 1rst 1rst ribrib andand collarbonecollarbone
�� ShouldersShoulders thatthat are are roundedrounded, , forwardforward & & elevatedelevated
�� SustainedSustained use use ofof pectoral musclespectoral muscles�� BreathBreath holding & holding & irregularirregular
breathingbreathing patternspatterns
MSI MSI specificspecific disordersdisordersThoracicThoracic outletoutlet syndromesyndrome
�� ViolinistsViolinists, , violistsviolists on on leftleft sideside ((securingsecuring instrument instrument betweenbetween chinchin andand shouldershoulder) )
�� GuitarGuitar playersplayers on on leftleft�� FluteFlute playersplayers bothboth sidessides ((flexingflexing shouldersshoulders forwardforward, ,
reachingreaching leftleft armarm acrossacross body, body, controllingcontrolling breathingbreathing))�� KeyboardKeyboard ((roundedrounded shouldersshoulders, , armsarms forwardforward, , headhead
forwardforward, , irregularirregular breathingbreathing patterns)patterns)
MSI MSI specificspecific disordersdisordersNerve compressionNerve compression
�� SciaticaSciatica�� Pain in legs Pain in legs andand buttockbuttock�� Can Can occuroccur atat anyany levellevel�� SittingSitting, , bendingbending slightlyslightly
forwardforward, , rotatedrotated to to oneonesideside
�� SittingSitting surface surface tootoo highhigh, , square on square on edgeedge ofof front front ofofseatseat →→ compression compression backbackofof legleg
MusiciansMusicians andand MSIMSI
�� OverviewOverview ofof healthhealth issuesissues�� Musculoskeletal injuriesMusculoskeletal injuries
�� AnatomyAnatomy�� SpecificSpecific diagnosesdiagnoses�� RiskRisk factorsfactors�� PreventionPrevention�� TreatmentTreatment
MusiciansMusicians andand MSIMSIRiskRisk factorsfactors
(SHAPE(SHAPE--Preventing MSI for Musicians and DancersPreventing MSI for Musicians and Dancers--A Resource Guide, 2002)A Resource Guide, 2002)
Diseases or health conditions Diseases or health conditions (pregnancy, diabetes, (pregnancy, diabetes,
osteoporosis)osteoporosis)
LightingLighting
Psychological stressPsychological stressVibrationVibrationSurfaces (floors)Surfaces (floors)
Addictive substancesAddictive substances(tobacco, alcohol, narcotics)(tobacco, alcohol, narcotics)
Contact stressContact stress(sharp edges)(sharp edges)
Layout or configuration of Layout or configuration of equipmentequipment
PosturePostureLongLong--duration activities duration activities (inadequate rest)(inadequate rest)
EquipmentEquipment
NutritionNutritionRepetitionRepetitionLayout of spaceLayout of space
Physical fitnessPhysical fitness(strength, flexibility, (strength, flexibility,
endurance)endurance)
Forceful exertionForceful exertionConfined spaceConfined space
Age & genderAge & genderAwkward posturesAwkward posturesTemperatureTemperature
Personal characteristicsPersonal characteristicsPhysical demandsPhysical demandsEnvironmental aspectsEnvironmental aspects
ArtisticArtisticDirectorDirectorComposerComposerConductorConductor
MusicianMusician
TechnicalTechnicalSoundSound engineerengineerStage managerStage managerTechnicalTechnical directordirectorPiano tunerPiano tuner
Venue designVenue designEquipmentEquipment designerdesignerInteriorInterior designerdesignerArchitectArchitectPurchaserPurchaser
AdministrativeAdministrativeUnionUnionFundingFunding agencyagencyRegulatoryRegulatory bodybodyCompanyCompany managermanager
EarlyEarly developmentdevelopmentSchoolSchool boardboardMusic Music instructorinstructorParentParent
Influences on risk of injury in musicians(SHAPE(SHAPE--Preventing MSI for Musicians and DancersPreventing MSI for Musicians and Dancers--A Resource Guide, 2002)A Resource Guide, 2002)
MusiciansMusicians andand MSIMSIRiskRisk factorsfactors for for musiciansmusicians
�� A change in technique or instrumentA change in technique or instrument�� Intense preparation for performanceIntense preparation for performance�� Overly strenuous repetition of demanding musical phrases*Overly strenuous repetition of demanding musical phrases*�� Sudden increase in duration or intensity**Sudden increase in duration or intensity**�� Preparation of a new or difficult piecePreparation of a new or difficult piece�� Prolonged performance without adequate rest*Prolonged performance without adequate rest*�� Lack of warm up*Lack of warm up*�� CombinationCombination
�� Challenging scheduleChallenging schedule�� Poor dietPoor diet�� Pressure to perfectPressure to perfect�� Performance anxietyPerformance anxiety
•• **ZazaZaza and Farewell 1997; and Farewell 1997; PaullPaull and Harrison 1997; and Harrison 1997; KellaKella 19971997•• ** ** ZazaZaza and Farewell 1997; and Farewell 1997; KellaKella 1997; Norris 1993; 1997; Norris 1993; ChongChong et al 1989et al 1989
MusiciansMusicians andand MSIMSI
�� OverviewOverview ofof healthhealth issuesissues�� Musculoskeletal injuriesMusculoskeletal injuries
�� AnatomyAnatomy�� SpecificSpecific diagnosesdiagnoses�� RiskRisk factorsfactors�� PreventionPrevention�� TreatmentTreatment
MusiciansMusicians andand MSIMSIPreventionPrevention
�� LevelLevel 11--Controlling Controlling riskrisk factorsfactors�� DevelopingDeveloping & & adheringadhering to warm up routineto warm up routine�� RestRest breaks breaks thatthat leaveleave youyou feeling feeling refreshedrefreshed�� Longer Longer restrest breaks breaks requirerequire anotheranother warm upwarm up�� GradualGradual increasesincreases to to thethe durationduration andand intensityintensity ofof practicepractice
ZazaZaza 19941994
�� LevelLevel 22--Recognizing Recognizing signssigns & & symptomssymptoms andandrespondingresponding appropriatelyappropriately
MusiciansMusicians andand MSIMSIPreventionPrevention--Controlling risk factorsControlling risk factors
�� Musician has most control during practice sessionsMusician has most control during practice sessions�� Focus on practice habits but also implement prevention during reFocus on practice habits but also implement prevention during rehearsals hearsals
& performances when possible& performances when possible�� Maintain personal health, fitness and nutritionMaintain personal health, fitness and nutrition�� Carry and set up equipment safelyCarry and set up equipment safely�� Maintain body awarenessMaintain body awareness�� Know your limits Know your limits
(balance physical & psychological demands) (balance physical & psychological demands) �� Adjust practice schedulesAdjust practice schedules
�� Vary difficulty of musicVary difficulty of music�� Good playing techniqueGood playing technique�� Select appropriate instruments and furnitureSelect appropriate instruments and furniture
MusiciansMusicians andand MSIMSIMaintainMaintain personalpersonal healthhealth, fitness , fitness andand nutritionnutrition
�� AllAll aspects aspects ofof dailydaily livingliving�� NutritionNutrition�� HydrationHydration�� PhysicalPhysical activityactivity�� SleepSleep qualityquality�� Stress managementStress management�� Smoking, Smoking, alcoholalcohol, , coffeecoffee, , drugsdrugs decreasedecrease bloodblood flowflow, ,
interfereinterfere withwith normal nerve normal nerve functionfunction, , alteralter judgementjudgement, , decisiondecision makingmaking
Musicians and MSIMusicians and MSISelect appropriate practice locationSelect appropriate practice location
�� Cold Cold �� ↓↓ bloodblood flowflow to to fingersfingers�� ↓↓ lubricationlubrication tendons & jointstendons & joints�� ↓↓ nerve conduction nerve conduction velocityvelocity
�� PoorPoor lightinglighting�� Compromises Compromises abilityability to to readread musicmusic�� Compromises Compromises playingplaying postureposture�� EyeEye strainstrain
MusiciansMusicians andand MSIMSISelect Select properlyproperly heatedheated & & wellwell lit lit environmentenvironment
�� Use portable Use portable tasktask lampslamps, , batterybattery poweredpowered clip clip lightslights�� RegularRegular eyeeye exam & corrective exam & corrective eyeeye wearwear�� AdequateAdequate clothingclothing�� WarmWarm hands hands
�� FingerlessFingerless glovesgloves, , wholewhole body exercice body exercice
MusiciansMusicians andand MSIMSIDevelopDevelop goodgood practice habitspractice habits
�� Warm upWarm up�� ↑↑ bloodblood flowflow�� WarmsWarms muscles muscles andand jointsjoints
�� 2 components: Joint rotation & 2 components: Joint rotation & aerobicaerobic warm upwarm up�� GentleGentle smoothsmooth motions x motions x severalseveral minutesminutes�� An An aerobicaerobic warm up for 5 minutes : warm up for 5 minutes : rapidrapid walkwalk, slow , slow jogjog, , skippingskipping�� Slow long notes Slow long notes beginningbeginning practice, practice, rehearsalrehearsal, performance, performance�� GradualGradual increaseincrease to to durationduration & & intensityintensity ofof practicepractice
�� Stretching Stretching controversialcontroversial�� SeekSeek medicalmedical adviceadvice on on properproper techniquestechniques
MusiciansMusicians andand MSIMSITaking rest breaksTaking rest breaks
�� Mitigates stress (physical & psychological)Mitigates stress (physical & psychological)�� Allows physical recovery of tissuesAllows physical recovery of tissues�� May enhance learningMay enhance learning�� Avoid muscle fatigueAvoid muscle fatigue�� Schedule rest breaks into practice sessionSchedule rest breaks into practice session
�� 5 min rest for 25 minutes playing5 min rest for 25 minutes playing�� 10 min rest for 50 min playing10 min rest for 50 min playing�� 1010--15 min rest for 30 min playing15 min rest for 30 min playingZazaZaza 1994; 1994; KellaKella 1997; Norris 19931997; Norris 1993
�� Spread practice time throughout the day Spread practice time throughout the day KellaKella 19971997
Musicians and MSIMusicians and MSIAvoid repetitionAvoid repetition
�� Variety of music & exercisesVariety of music & exercises�� Build in time for simpler piecesBuild in time for simpler pieces�� Use imaging and visualizationUse imaging and visualization
�� Note by noteNote by note�� Movement by movementMovement by movement�� Assists cognitive aspects of learningAssists cognitive aspects of learning�� Enhances speed of motor learningEnhances speed of motor learning�� Reduces physical practice time & physical risk of injuryReduces physical practice time & physical risk of injury
MusiciansMusicians andand MSIMSISelect Select appropriateappropriate instrumentsinstruments
�� WellWell maintainedmaintained andand wellwell designeddesigned**�� AvoidAvoid leakyleaky valves or padsvalves or pads�� AvoidAvoid bridges bridges thatthat are are tootoo highhigh�� AvoidAvoid excessexcess deaddead spacespace atat top top ofof piano piano keyskeys* Norris 1993* Norris 1993
�� Instrument Instrument thatthat fitsfits thethe musicianmusician
MusiciansMusicians andand MSIMSISelectingSelecting andand adjustingadjusting furniturefurniture
�� Chairs & Chairs & stoolsstools adjustedadjustedsoso feetfeet flat on flat on floorfloor
�� Chair Chair tootoo short short andand notnotadjustableadjustable??�� AddAdd a a cushioncushion�� StackStack chairschairs�� WoodenWooden blocks blocks underunder
chair chair feetfeet ((carefulcareful))PaullPaull andand Harrison 1997Harrison 1997
�� Chair Chair tootoo talltall??�� FootrestFootrest ((phonebookphonebook))
MusiciansMusicians andand MSIMSISittingSitting posture posture
�� DependsDepends on instrumenton instrument�� MaintainMaintain lowlow backback curvecurve
�� LumbarLumbar pillowpillow�� WedgeWedge cushioncushion�� Lift Lift backback legs legs ofof chairchair
�� Foot Foot widthwidth�� WideWide basebase
�� FeetFeet in front in front ofof kneesknees�� VaryVary positionposition
MusiciansMusicians andand MSIMSISelectingSelecting andand adjustingadjusting furniturefurniture
�� AdjustAdjust musicmusic standsstands�� SheetSheet musicmusic atat eyeeye
levellevel or or belowbelow�� LowerLower eyeseyes ratherrather thanthan
headhead�� DirectlyDirectly in frontin front
MusiciansMusicians andand MSIMSIPreventionPrevention--variousvarious gadgetsgadgets
MusiciansMusicians andand MSIMSIPreventionPrevention--HarnessesHarnesses
�� tubas, drums & tubas, drums & saxophonessaxophones
MusiciansMusicians andand MSIMSIGuitarGuitar strapsstraps, , beltsbelts & supports& supports
MusiciansMusicians andand MSIMSIPreventionPrevention--StandsStands
MusiciansMusicians andand MSIMSIPreventionPrevention
VariousVarious gadgetsgadgets�� HighHigh chinchin restsrests((violinsviolins, violas), violas)
MusiciansMusicians andand MSIMSICarry Carry andand set set upup equipmentequipment safelysafely
�� Plan liftPlan lift�� AvoidAvoid twistingtwisting & & rapidrapid liftinglifting�� How How heavyheavy isis loadload??�� Stable baseStable base�� Face itemFace item�� SolidSolid gripgrip�� ClearClear route AND TAKE YOUR TIME!route AND TAKE YOUR TIME!
MusiciansMusicians andand MSIMSIUsingUsing appropriateappropriate containerscontainers
�� Not Not tootoo heavyheavy�� WellWell constructedconstructed, , paddedpadded handleshandles & & wheelswheels�� 2 trips 2 trips betterbetter thatthat 11�� EnoughEnough peoplepeople carryingcarrying? ? GetGet helphelp�� DollyDolly�� AvoidAvoid lifting if lifting if injuredinjured�� GiveGive yourselfyourself enoughenough timetime
Musicians and MSIMusicians and MSIPractising body awarenessPractising body awareness
Movement disciplinesMovement disciplines�� Alexander techniqueAlexander technique�� FeldenkraisFeldenkrais MethodMethod�� PilatesPilates�� YogaYoga�� Tai ChiTai Chi
GOAL is a better sense of posture, movement, GOAL is a better sense of posture, movement, status of bodystatus of body
MusiciansMusicians andand MSIMSIPractising body awarenessPractising body awareness
A A betterbetter sensesense ofof posture, posture, movementmovement, , statusstatus ofofbody body →→
�� ↑↑ AbilityAbility to to choosechoose appropriateappropriate playingplaying postureposture�� ↑↑ fluidityfluidity ofof movementmovement�� ↑↑ understandingunderstanding ofof differencedifference betweenbetween normal normal
fatigue fatigue relatedrelated discomfortdiscomfort versus pain due to versus pain due to injuryinjury
MusiciansMusicians andand MSI: MSI: TreatmentTreatment
�� LevelLevel 1: 1: recognizingrecognizing signssigns & & symptomssymptoms andandadministeringadministering selfself--helphelp techniquestechniques
�� LevelLevel 2: 2: recognizingrecognizing whenwhen signssigns & & symptomssymptoms are are persisitentpersisitent & & unusualunusual thenthenseekingseeking professionalprofessional medicalmedical helphelp
MusiciansMusicians andand MSI: MSI: TreatmentTreatment
�� Warning Warning signssigns & & symptomssymptoms�� DiscomfortDiscomfort, pain, , pain, tinglingtingling, , numbnessnumbness whilewhile
playingplaying�� WeaknessWeakness in hands or in hands or difficultydifficulty withwith fine control fine control
ofof fingersfingers�� StiffnessStiffness�� Postural changes (Postural changes (elevatedelevated andand or or roundedrounded
shouldersshoulders))�� Local Local swellingswelling or or roundnessroundness�� DO NOT PLAY THROUGH PAINDO NOT PLAY THROUGH PAIN
MusiciansMusicians andand MSI: MSI: TreatmentTreatmentRICE RICE treatmenttreatment protocolprotocol
�� RESTREST�� ICEICE
�� ↓↓ BloodBlood flowflow & sensation& sensation�� 1515--20 minutes20 minutes�� Not Not directlydirectly on skin (on skin (frozenfrozen peaspeas in in dampdamp toweltowel))�� No No creamscreams, , balmsbalms, , rubsrubs�� Do Do notnot use to use to numbnumb pain to pain to keepkeep performingperforming
�� COMPRESSION (COMPRESSION (askask healthhealth professionalprofessional))�� ELEVATION (ELEVATION (aboveabove levellevel ofof heartheart))
MusiciansMusicians andand MSIMSIWhenWhen to to seekseek medicalmedical assistanceassistance
�� SymptomsSymptoms occuroccur eacheach timetime youyou playplay�� SymptomsSymptoms continue to continue to worsenworsen�� SymptomsSymptoms unusualunusual for for youyou�� SymptomsSymptoms persistpersist afterafter practisingpractising�� SymptomsSymptoms occuroccur atat otherother timestimes i.e. i.e. duringduring sleepsleep�� SeekSeek healthhealth care care professionalprofessional experiencedexperienced in in
treatingtreating musiciansmusicians
MusiciansMusicians andand MSIMSIMultidisciplinaryMultidisciplinary approachapproach
�� MusicianMusician�� HealthHealth care providerscare providers�� TeachersTeachers�� EquipmentEquipment providersproviders�� Instrument providers Instrument providers �� FurnitureFurniture providersproviders
MusiciansMusicians andand MSIMSIRemindersReminders
�� IdentifyIdentify aspects aspects ofof set set upup, practice habits, , practice habits, playingplayingposture posture atat faultfault
�� IncreaseIncrease restrest, , decreasedecrease continouscontinous playingplaying ((untiluntil youyou playplaywithoutwithout symptomssymptoms))
�� GradualGradual smoothsmooth warm upwarm up�� BeBe awareaware ofof passages passages contributingcontributing to to signssigns & & symptomssymptoms
thenthen reducereduce intensityintensity & & levellevel ofof repsreps�� PerformPerform long slow notes, long slow notes, simplersimpler passages passages followingfollowing
complexcomplex passsagespasssages�� AlternateAlternate physicalphysical practice practice withwith mental practicemental practice
Question Question periodperiod