PLAYING-RELATED PAIN AND HEALTH ISSUES

Artists' Health Insurance Resource Center, USA

Quality health insurance differs greatly from state to state. The AHIRC database was created in 1998 by The Actors’ Fund of America, with a grant from the National Endowment for the Arts, as a health insurance resource for artists and people in the entertainment industry.

Arts Medicine

Arts & Sports Medicine (MA) 

Beta-Blockers

The Centre for Manual Physiotherapy
Musician’s Injuries

Harkness Center for Dance Injuries
New York

Institute of Music Physiology and Musicians' Medicine
Germany

MDPA-Rebecca Clearman
Houston-Texas

Miller Health Care Institute
 for Performing Artists
New York

Medical Clinics for Performers
US and Canada

Montreal Tinnitus Clinic

Orleans Centre for Physiotherapy
Ottawa, Canada

Performing Arts Medicine Program
Indiana University Medicine Program
of The Christ Hospital
Cincinnati

Rotator Cuff Injury

RSI Clinic
Toronto

Sanart
Madrid

SportBallet

UNT Musician Health Survey
University of North Texas

Voice Disorders

Carpal Tunnel Syndrome

by Mark Pippenger, M.D.
Assistant Professor of Neurology and Geriatrics
University of Arkansas for Medical Sciences
Interim Clinical Core Leader, UAMS Alzheimer's Disease Center
4301 West Markham Street, #500
Little Rock, Arkansas  72205


As a neurologist, I'm extremely familiar with Carpal Tunnel Syndrome (CTS), a disorder in which the median nerve is compressed at the wrist. Typical symptoms are numbness in the first 3 digits of the affected
hand, which may initially come and go, especially at night. The disorder can categorically be diagnosed as present or absent through the use of NCS, "Nerve Conduction Studies" (older docs may still call it "NCV" or "Nerve Conduction Velocity," though a proper study includes much more than just velocities).  EMG ("Electromyography") is not necessary to diagnose the condition (this involves insertion of needles into muscles and recording of impulses from the muscles).
Non-neurologists often use the EMG in diagnosing CTS, however (but it's
not necessary, just the NCS is needed).

There are several myths about CTS, chief among these that you can cause CTS by using a keyboard.  This has been disproved in well-designed
studies (but is still held onto by people like personal injury lawyers, who stand to gain by trying to link a medical illness to someone who can be sued).  What is likely is that if you use a keyboard a lot and have mild CTS, you're much more likely to notice it.

It is true that the median nerve is pulled against the wrist ligaments
by flexion of the wrist--bending the hand forward, like some people do
when holding a fiddle, for example.  Extending the wrist (bending the
hand back slightly) relaxes the nerve slightly.  So, one of the
conservative treatments involves use of a "cock-up" wrist splint, which
holds the hand in a slightly extended position--the splint can often
just be worn at night and the symptoms relieved (it's hypothesized that
the condition might be aggravated by repeatedly flexing the wrist in
sleep).  Some people wear them around all day, however.  This is the
least invasive non-surgical therapy.


Acupuncture has not been studied in well-designed studies, partly
because it's hard to do with acupuncture (hard to have a placebo arm of
therapy, for instance).  What studies have been done are promising
using traditional acupuncture.  So-called "laser acupuncture" has so
far shown no benefit in treating CTS. 

Chiropractic adjustment of the
neck or back can have no effect whatsoever on actual CTS, as CTS
involves a nerve problem in the wrist (though I've had chiropractors
argue with me that the problem really, at its "heart," is a problem of
spinal misalignment--these people are, to be charitable, unscientific).
There is a good, evidence-based review of non-surgical treatments for
CTS to be found in the Cochrane Database of Systematic Reviews,
2003;(1):CD003219.

Surgery is considered the definitive treatment, though it doesn't
always work.  Unfortunately, surgery is often done without proper
diagnosis--people often complain of numbness in the fingers, and
surgeons sometimes just operate without getting NCS.  Very often, those
people don't have CTS at all, so the surgery doesn't help.  When it's
properly diagnosed, surgery is usually (but, again, not always)
curative.
Reprinted with permission from Dr. Mark Pippenger.

Earplugs for Musicians

Custom Ear Plugs for Musicians

Ear Plug Superstore

Hearing Protection

Musicians: Hearing Loss and Hearing Protection

Sonomax

Wikipedia

Hearing Loss in Musicians

CLASSICAL MUSIC And Hearing Loss
Danger: Music zone
Decibel assault on performers' ears isn't relegated to rock shows
 the classical ranks deal with it too 

By Louise Roug
Tribune Newspapers: Los Angeles Times
September 8, 2004

For violinist Matthew Faust, things finally got so bad that playing in big orchestral works felt like being in a war zone. Even his "full metal jacket" -- custom-molded earplugs with maximum filters -- wasn't enough to protect him.

"I needed a crash helmet," he says.

To Seth Mausner, a violist with the San Francisco Symphony, the experience can feel like "being assaulted."

Marcia Dickstein, a harpist who often performs with Los Angeles Opera and the Long Beach Symphony, likens it to "somebody driving nails through your head."

At symphony concerts, audiences may thrill to a piece played at maximum volume. But if you're a musician sitting with your back to the brass section, the sensation can be overwhelming.

An often-cited study by Canadian audiologist Marshall Chasin measured hearing loss among rock musicians and found that about 30 percent were afflicted in some way. Among their classical music counterparts, the figure was 43 percent. Yet while noise-induced hearing impairment is a well-known issue in the rock world, long highlighted in educational campaigns featuring The Who's Pete Townshend and rapper Missy Elliott, the discomfort from loudness suffered by classical musicians is generally kept hush-hush.

Serious issue

"Classical musicians do suffer from hearing loss related to the volume of sound onstage," says Steven Braunstein, a bassoonist with the San Francisco Symphony. "It's a real problem for many people," especially if "you have four trumpets and four trombones right behind your head. It gets very, very loud."

Measured in decibels, in fact, symphonic sound can soar up to 110, equivalent to the sound of a jackhammer or power saw.

Last year, the European Union set a maximum limit of 85 decibels for the workplace, including concert halls, in a directive that generated derision but also debate.

In the United States, where symphony halls are regulated by the Occupational Safety and Health Administration (allowing a 90-decibel level over an eight-hour day in any workplace), nobody is suggesting scrapping Mahler. But to guard against debilitating decibels, an increasing number of orchestras are experimenting with unorthodox seating arrangements, motorcycle windshields and firing-range earplugs.

As music moved from 18th Century private salons to 20th Century concert halls, small chamber ensembles -- often a group of string and woodwind players -- grew into symphony orchestras with large brass and percussion sections.

"Composers want more people onstage, more sound, and the instruments become super-charged," says UCLA musicologist Robert Fink, describing this evolution. "What happens between Mozart and Mahler is the industrialization of the orchestra. Orchestras become analogous to factories where sound is produced. You punch in; you punch out. And at the same time, the instruments are getting more efficient."

Loud is in.

As brass instruments, in particular, became bigger, the orchestra's sound increased. At the same time, so did audience expectations.

The result is that music "has gotten more exclamation points," says Florence Nelson, a piccolo player and secretary-treasurer of the American Federation of Musicians. "People want that today. They want that loud sound."

Onstage, though, rapture sometimes gives way to misery.

"There's a kind of loud where everything starts vibrating, and it's thrilling, right on the edge of being painful," says harpist Dickstein. "Then there are the times when I'm right in front of the timpani, and I start to cry, my eyes start to water, and I have to put my head between my knees to plug in the earplugs."

In a survey of more than 400 musicians, Allison Wright Reid, a British health and safety expert, found that close to 80 percent had experienced pain because of loud noise, and about a third complained that their hearing had become duller.

"You don't go stone deaf," says Reid, who wrote "A Sound Ear," a report sponsored by the Association of British Orchestras. Rather, musicians may lose their perfect pitch, or experience increasingly inaccurate and unreliable hearing with "all sorts of extra noise thrown in," she says. "It's like driving a very old car: You don't know if it's going to get you there, and it constantly worries you because [of the] noise."

In practical terms, loud noise can destroy the tiny hairs in the inner ear that translate sound waves into nerve impulses for the brain.

Blunt trauma -- an explosion or other high-impact sound -- can cause immediate and permanent hearing loss. But hearing can also be damaged gradually by constant exposure to an above-normal decibel range, with the damage manifest as a limited ability to pick up certain frequencies -- a sort of muffled sensation -- or as tinnitus, a constant buzzing or ringing tone.

The risk faced by musicians depends on what section of the orchestra they are seated in, what instrument they play, how often they perform and rehearse, acoustics and repertory.

And noise damage doesn't stop at the ear.

Among brass players, for example, the force needed to play at very high levels can also result in torn lip muscles and damage to the control of the soft palate.

According to several studies, musicians may also experience an accelerated heart rate, increased blood pressure, muscle contractions, tension, irritability and anger.

"Initially I didn't tell anyone about it," violinist Faust, 43, says about the hearing problems he began having in 1990. In orchestras, "there's a little machismo. It's something you don't share. It's seen as sort of a weakness."

At first, Faust's doctor said he was suffering from sensorineural hearing loss caused by noise. Eventually, Faust developed tinnitus. Having hoped since high school "to win a chair in a full-time orchestra," he tried earplugs, acupuncture and herbs, as well as moving to quieter sections of the orchestra.

Concerned management

The management of the Oregon Symphony, his employer, was helpful and sympathetic, but its concern wasn't sufficient. Faust acquired "a phobia," he says. "You develop a fear of loud sounds."

During concerts, he was trapped.

Finally, Faust, who fell in love with the violin at age 5, went on disability last year.

While some British orchestra "noise teams" have considered changes to the standard repertory, American orchestras have preferred less drastic measures to avoid damage and discord.

Backstage at Walt Disney Concert Hall, free foam earplugs are available for players. In San Francisco, plexiglass shields have been attached to orchestra chairs -- a common, if imperfect, sound barrier.

Some players spend hundreds of dollars themselves on custom-made earplugs. As a result, a cottage industry has grown up around musicians' ears.

Whereas foam earplugs reduce the sound in high frequencies, making everything sound muffled, these high-tech plugs offer better fidelity by reducing volume across the spectrum.

Audiologist Lisa Tannenbaum used to sell hearing aids but decided she preferred "the preventive side of things." These days, she makes earplug molds for as many as 40 ears in a day.


Copyright © 2004, Chicago Tribune

Playing (less) Hurt: An Injury Prevention Guide for Musicians

A guide and reference for everyone concerned with pain in musical work: professional and amateur musicians, teachers, students, doctors and therapists.
Horvath has been the Minnesota Orchestra's Associate Principal Cellists for more than two decades.

Pump Down the Volume

"If you're an orchestral musician you could be at serious risk of long-term hearing damage. Janet Horvath looks at some simple and effective solutions." "The Strad" (December 2004)

Crafting a Comeback
Regaining your chops after a layoff can take less time if you take it slow
By Susan M. Barbieri

Institute of Physiology and Medicine of Art - Terrassa
Barcelona, Spain

 

YOU ARE YOUR INSTRUMENT: (book by Julie Lyonn Lieberman) 152 pages with 40 illustrations & 40 photos. A comprehensive guide to help any musician heal existing injuries & develop a more enjoyable physical/mental experience during practice & performance. Includes anatomy charts & a Directory of Mental & Physical Therapies. (Huiksi Music) To Order: Call 1-800-484-1333 and key in access code 8400; or send a check for $24.00 postpaid (add $4.00 postage outside U.S.) to Huiksi Music, P.O. Box 495, NY, NY 10024. Distributed by IPG to bookstores & Distributed by Hal Leonard to music stores worldwide.

THE INSTRUMENTALIST'S or THE VOCALIST'S GUIDE TO FITNESS, HEALTH & MUSICIANSHIP: Two videos designed as companions to "You Are Your Instrument." Julie coaches famous musicians, presents important exercises & tips, uses a physical fitness trainer -- all to present important relaxation, healing, & movement techniques to counteract the physical problems which often surface after long hours of performing or practicing. She even has a panel of experts on the Vocalist's video. Homespun Tapes (1-800-33-TAPES in the US) Hal Leonard in the UK.

THE VIOLIN IN MOTION: An Ergonomic Approach To Playing For All Levels & Styles (video) Julie Lyonn Lieberman presents a much-requested 60-minute private lesson on video. Her unique approach challenges the age-old "do as I do," & offers students a physiological basis for building effortless, fluid technique based on individual body type. Julie offers dozens of key technical tips as well as a ten-minute exercise program. (Huiksi Music) To Order: Call 1-800-484-1333 and key in access code 8400; or send a check for $44.50 postpaid (add $4.00 postage outside U.S.) to Huiksi Music, P.O. Box 495, NY, NY 10024. Distributed by Hal Leonard to music stores worldwide.

Medicine Sites

MusicalOnline

 
Musicians and Injuries

 
Musiikkilääketiede Savonlinna
 Arts Medicine
Finland

Performing Arts Medicine
Ithaca College

Performing Arts
 Medicien Clinics
U.S.A.

Tuba Lips, Guitar Nipples
and Other Musical Maladies
By Stephanie Mencimer
The Washington Post
Tuesday, March 25, 2003

Medical Aids

Latex Finger Cots

Care of Skin in Winter
Recommended by dermatologists
 It's terrific

 New Skin

Use New-Skin Liquid Bandage when something tougher and more flexible than
 a regular bandage is needed
 or when the wound needs to breathe.

Nexcare
3M
Skin Crack Care

De Quervain's syndrome is the swelling and inflammation of the tendons or tendon sheaths that move the thumb outward. The main symptom is aching pain on the thumb side of the wrist and at the base of the thumb, which becomes worse with movement. As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called "crepitus." A finger may lock in an upward position as the person tries to straighten it. If the condition is bad, there may be swelling along the tunnel near the edge of the wrist. Grasping objects with the thumb and hand may become increasingly painful. Aids for Thumb Tenosynovitis:

Formedica Thumb Stabilizer: available in drug and medical supply stores.

The thumb stabilizer relieves pain due to tendosynovitis. It provides relief in the thumb tendons (Quervain syndrome). Recommended for post-surgical support and effectively relieves the pain of arthritis and osteoarthritis.

Trigger finger

A band-aid worn on the joint during the day keeps the thumb from bending and relieves pain.  Nexcare 3M bandages are very strong, and they come in nice colors "Active Brights."  It can also have good results in restoring use of the affected thumb (or finger) in some cases.

For performances, clear tape works best because it cannot be seen easily. Nexcare plastic tape is very good.

Suggestion:

Lois Siegel's Home Page