Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

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Disempowerment in Injury Treatment and Recovery

I just thought this article  needed a picture.

I just thought this article

needed a picture.

      So I’ve previous discussed Injury Shaming in the music field, as specifically related to employment, education, festivals, etc.  However, I did want to discuss some of the other issues related to injury treatment and recovery, as pertaining to musicians.  First, let's look at some of the problems with seeing medical professionals about a musical issue.

1.  The classic answer to overuse injuries, which sometimes prevents musicians from seeking medical attention for more serious issues, is "stop playing and take some anti-inflammatory drugs."  Let’s be clear, rest is important. But if the solution is to tell people to completely stop their career without looking at the whole picture of what’s creating an injury, we’re setting up for a problem. While there are some fabulous medical professionals out there willing to look deeper, many musicians don't seek help as quickly as they might otherwise because they receive a less-than-helpful answer for a long term solution.  If music is your profession and how you make money, then having a medical professional dismiss your concerns is incredibly insulting.  

Also, about those anti-inflammatory drugs- inflammation is your body's way of bring more blood to an area that has been damaged, irritated, infected, etc.  It can be a way of protecting against further damage, (unless we're talking chronic inflammation, which changes the type of cells present at the site), and is accompanied by pain, swelling, redness, and heat.  When we constantly and repetitively take NSAIDs (non steroidal anti-inflammatory drugs), we are disrupting our body's process for dealing with tissue damage.  

"Overuse of the muscles causes cells to break down, releasing waste products, which produces pain and inflammation.  Cleanup crews in the form of white blood cells, known as macrophages, carry away the cellular debris.  If you take anti-inflammatory drugs, the natural inflammation process is disrupted and instead of being cleansed away in the bloodstream, the trash settles into scar tissue."  (Emil Pascarelli, Repetitive Strain Injury for Computer Users, New York: Wiley, 1994) 

Interesting.  Another stat I heard in an interview with Jonathan FitzGordon stated that while Americans make up only 4.5% of the world's population, we use 80% of the world's (!) pain-killers.  Yikes!  Maybe it's time to reconsider a few things?

2.  While healthcare reform is a great thing for us musicians, especially freelancers, it's been a long time coming, and many of us have had to pay for some expensive stuff along the way.  Because of my pre-existing condition, I was denied healthcare and paid out of pocket, which was awful.  Even now, many insurance policies have a high deductible which may discourage patients from seeking the treatment they need because of the high up front cost.   (If a deductible is $1500, that means that you will pay all costs up to that deductible, which can be a lot of money!  MRI's are very expensive...)  In addition, that can prevent musicians from getting the PT, regular check ups, and care they need long-term.

3.  Many homeopathic and alternative treatments are not covered by insurance- acupuncture, chiropracter, rolfing, etc.  For a musician in a professional orchestra with a good salary, that might be ok, but for a freelancer or someone with a lower salary, paying $140 for one session is prohibitive.  I had a rolfing session (structural integration) which was amazing, and really changed how I felt in my muscles and soft tissues, but it was really expensive and I can't justify going again for a long time.  I would love to see more professionals offer their services at a discounted or sliding rate for people who could benefit from their services but can't afford it.  I know there are quite a few great community acupuncture clinics in the US-what about sliding scale rates for other modalities?  Yoga, pilates, and gyms can be outrageously (!) expensive, and I know that also turns people off too.  In my fantasy land, orchestras, schools, and arts organizations would make health a priority for their employees/students by supporting these resources, rather than expecting students to pay out of pocket.

4.  Many musician injuries are chronic.  A musician might stop playing for a bit, and feel ok, and then 6 months later, the pain comes back.  We need to both look at our own actions and how we're contributing to our own pain, but we also need medical professionals who are interested in creating long term change, not just a treatment of symptoms.  It's a combination of taking responsibility for one's own health, combined with assistance from homeopathic and allopathic folks interested in changing the problem, not the symptoms.

5.  Lastly, it's really hard to be injured, in pain, or with undiagnosed symptoms of illness. A few years ago, I was consistently unwell.  I had headaches, digestion issues, low energy, etc., many of which were difficult to treat or identify.  After a period of a few months, I was eventually diagnosed with a non-cancerous pituitary brain tumor, which explained a lot of my issues.  Yet, during that time of non-diagnosis, I felt terrible.  Generally, we like to take steps in maintaining our health, to be in control if possible.  If we move enough and eat vegetables and sleep well, we expect to feel ok.  When those things don't happen, it can be devastating, regardless of the injury or issue.  RSI's don't go away quickly, and there's rarely a quick fix solution.  The process of healing and diagnosis can be very stressful in and of itself, especially if the body doesn't heal itself quickly.  That combines with the stress of school or a job and a lack of compassion in both the medical and job/education setting can be damaging long term.     


Is Yoga for Everyone? Yes...and No.

Many of you know me as a violist/yoga teacher, which often leads people to think that I want everyone to do yoga.  This is not true, and here's why: Yoga is not a magical therapeutic movement modality, as many people seem to think it is, and many "traditional" poses can be quite injurious. Yoga still has the power to be a transformative and amazing movement modality, but not all yoga practices and classes are equal, nor are they all beneficial for musicians (and normal people).   Side note, the initial conception of yoga was multilayered, not just consisting of poses.  There are other limbs of yoga that are fantastic and worth exploring, they just don't always come up in the context of a one hour class.

BKS Iyengar shows off a HUGE range of shoulder mobility here in downward facing dog, which is not necessarily how the pose should look or should feel on anyone's body.  (Nor should everyone try downward facing dog at all!)

BKS Iyengar shows off a HUGE range of shoulder mobility here in downward facing dog, which is not necessarily how the pose should look or should feel on anyone's body.  (Nor should everyone try downward facing dog at all!)

Yoga asana, as taught in the west, is undergoing a revolution of thought, in that for many years, teachers and students have perpetuated the notion that "any pose is possible if you practice diligently."  This is simply not true, nor is it a helpful notion if you're working with restriction or past injury.  Every single body is different in terms of bony restriction, muscles, etc., and not every pose is right for every person.  I will most likely never get my foot behind my head, and I'm totally fine with that.

You may have heard comments in a classroom like "find your edge" and "push your limit" juxtaposed with contradictory statements like "listen to your body."  What the heck does that even mean?  If you're a musician with wrist issues or shoulder issues, those comments are not helpful, and don't help to find individual limits.  In addition, a majority of traditional yoga poses will put extra weight on the wrists (in extension, no less), and put the shoulders into extreme ranges of motion.  There is often a praising of people who can do the "hard poses" which often demand a lot of flexibility, often in extreme ranges, which shouldn't really be the "goal."  I've been in many a yoga class in which a difficult backbend series was called out, and the most bendy person was used as an example for what You or I might achieve if we work hard.  This is not necessarily true, and not necessarily in line with my goals as a movement practitioner.  For that reason, I've been re-evaluating my yoga practice and changing how I teach movement and yoga over the last few years.  I no longer seek out intense, end-range glorifying yoga classes, and I have a lot less attachment to specific complex poses.  I'm happy to never be the "demo" body for deep or complex poses, and I'd rather do my own thing in the back.  I love slow, down-regulating practices, that allow me to mindfully move with my body.  I also do other movement practices besides yoga, and don't expect yoga to be a complete body workout/movement plan.  Here are some considerations for starting yoga or just rethinking your yoga practice.

1. If you're interested in trying yoga but have a history of arm, wrist, or shoulder injuries, look for a class that has gentle, hatha, yoga therapy, slow, etc. in the title.  Even if you're healthy, it's great to start with the basics, even if you're a health and active person.    The more dynamic styles (flow, vinyasa, ashtanga) are difficult to jump right into, and often don't offer a range of accommodations for traditional poses (such as plank, chaturanga, DFD).  There isn't always time to break down poses either, as it is assumed that one is already familiar with them.

Kino McGregor is a famous (and pretty darn flexible) ashtanga teacher.  I have ZERO interest in getting here, nor is that really even on the radar for me.  If you can do it, great, if not, you can still live a happy yoga life without it.

Kino McGregor is a famous (and pretty darn flexible) ashtanga teacher.  I have ZERO interest in getting here, nor is that really even on the radar for me.  If you can do it, great, if not, you can still live a happy yoga life without it.

2. Doctors often tell patients to practice yoga if they have back pain, or tell them to strengthen their core.  This is not the most helpful advice, as there isn't necessarily a correlation between core strength and back pain.  More importantly, there are a million styles of yoga, and many would in fact be challenging for managing back pain.   Meeting with a teacher one on one, working with a yoga therapist, going to class aimed at back pain ...these will help more than a general class.   Group classes are not always a great way to get specialized attention, and one on one is infinitely more helpful, especially if you come in with injuries or a pain history.

3.  Read the biographies of your teachers or possible teachers.  Look for teachers with anatomical knowledge and experience who can tailor movement to you.  The last thing you want is a teacher who can't help you with form or modification, or who has no experience with shoulder or wrist injuries.

4. Try not to think of yoga as your workout.  When we think of yoga in this way, we often gravitate towards hot room/hard poses/move fast, which can often cloud our integrity of movement, especially if we're vulnerable physically.  If you're healthy and have never had a problem with hot room vinyasa/bikram, that's great, but for a beginner or sensitive person, I would say start slow and at room temperature!

5.  Ask yourself why you're doing yoga, what you like about it, and what your goals are.  (To be more flexible, to learn how to breathe better, to combine mind and body, whatever).  Make sure that the class you're attending serves that goal, and if not, try a different class, or a different movement practice.

6.  And lastly, only do as much as you can with integrity.  This is something I try to apply to most movement practices (crossfit! weight lifting!), but only do as much as you can with integrity of movement, good alignment, and feeling like you can breathe.  If a teacher or class is pushing you to a place you're not comfortable or able to go, don't do it.  I've skipped MANY a teacher cue, and done just fine.

At the end of the day, I like many things about yoga, and I dislike many things about yoga.  (That's a rant for a different day and a different blog).  I also like walking, swimming, jumping, lifting weights (yes), pilates, and trying different movement practices.  As a teacher, I also want my students and colleagues to be strong, mobile, and pain-free.  If another movement practice takes them there, that's great.  It doesn't have to be yoga.

A Flutist with a passion for Physical therapy: Alexis Del Palazzo

Alexis del Palazzo is a flutist turned DPT student, marathoner, and  "Musician with a passion for physical therapy." Naturally, I thought she'd be a great fit for our this community of readers and bodynerds, and I'm happy to have her contributions here!

Kayleigh: What is your background in music and performance?

Alexis: I began playing the flute in 6th grade band when I was 11 years old. Exhibiting innate musical talent, I sang all the time but the only real music education opportunity available to me in my rural school was band. My older brother had been in band, and I was so excited to join when I was old enough. 

In 9th grade, I decided I wanted to take music seriously and pursue a career. I started taking private lessons, and did everything I could to improve as a musician. A series of personal choices landed me in Oklahoma and I attended the University of Oklahoma where I studied with Valerie Watts, and I received a Bachelor of Music Performance degree in 2007.  At that time, I was burned out and I needed a day job so I took a break for about a year and a half. I built a small studio but I wasn’t performing during that time. In 2009, I rediscovered my passion and for a period of about 2 years, I focused on building my career and getting into a MM program.  That pursuit actually led me to physical therapy...

K: Tell us a bit about you got interested in physical therapy.

A: I never knew any physical therapists growing up, and my impression was that most of them were former athletes. A DMA student at OU who attended the school while I was an undergraduate had a previous background in physical therapy but that was the extent of my exposure to the field.  As I worked towards a MM program, one of my mentors and teachers during that time reawakened my interest in the body and movement. I reacquainted myself with my copy of Lea Pearson’s What Every Flutist Needs to Know about the Body and I attended the 2011 Andover Educator conference in New Jersey. At the conference, I met an Andover Educator who was also a hand therapist. During this time, I was having problems with my right arm. I was battling severe performance anxiety with huge adrenaline rushes that would make it difficult for me to play. In response, I would grip the flute incredibly hard and post-performance, I would have pain in my right forearm for hours afterwards. In spite of being prepared, my audition for grad school didn’t go very well - I was not only trying to play through extreme performance anxiety, but I was also playing through pain in my arm. The inflammation and pain was becoming more persistent.

I had a similar problem as an undergraduate but the doctor only prescribed me a hefty dose of ibuprofen and told me to rest. That advice was totally useless to me as a musician, and I was hesitant to see another medical professional. Meeting and talking with this person at the conference helped me decide to see a doctor again and ask for a referral to physical therapy. Because I was wary of being treated by a PT unfamiliar with the demands of being a musician, I first drove from Central Pennsylvania to the D.C. area for an evaluation with a physical therapist there (also a musician). She shared my evaluation results with my local PT, and we got to work. As I watched the clinic staff work with other patients during my treatment, my interest level increased and I began researching everything I could about physical therapy and what was involved with becoming a PT.

I was hooked. It took a month from the AE conference to receiving my own PT treatment to make a decision that this was what I wanted to do. In addition to educating musicians about moving better, I also wanted to be able to treat them as a medical professional.

K: Amazing!  How has your understanding of the body changed in your studies?  How has your own relationship with your body evolved?

Alexis' book,  The Practice Matrix.   Definitely worth checking out!

Alexis' book, The Practice Matrix.  Definitely worth checking out!

A: Life never happens the way you want it to. It took 2 years for me to arrive at a place where I was able to begin the huge list of pre-requisite courses needed to even apply to a program. In those 2 years, I became an Andover Educator trainee to train to teach the course What Every Musician Needs to Know about the Body™. I revamped my practice routine, and incorporated all the bodywork lessons and time management techniques I was learning during this time. Via Body Mapping and the Alexander Technique, I discovered what habits were hurting my playing and through intensive, patient work, I began making changes to my body map and I made huge strides in my playing. I even wrote a book to help other musicians incorporate the same kinds of changes into their practice routines.

Prior to starting work with Body Mapping and the Alexander Technique, my mind and body weren’t very well connected. As an introvert, I spend a lot of time in my mind and my thoughts tended to control me. I believed that I had no control over how I moved. The musculoskeletal system was also a huge mystery to me as well, and I had many mismappings to address. I began practicing mindfulness, and I learned that I did have a choice. I could choose to simply notice my thoughts but let them go. I could choose to stop a movement and replace in its stead a healthier, more efficient movement. And learning this with my flute helped me become a better human being, a better musician, and a better teacher.

In retrospect, I am so happy to have had that 2 year period to spend so much time on somatic bodywork. It helped me learn about my own body and help me develop my own self-awareness. These are all skills I can transfer into my own practice as a future physical therapist.

K: What's one thing you wish musicians knew about health, wellness, and body!

A: I wish that musicians would learn about health and wellness prior to being injured! I didn’t learn about the resources available to musicians until I was injured, and I regret not learning more sooner. Knowledge is power.

Learning the structures of the body and how it works, and learning how to keep your body healthy will prolong your musical life. Make time to learn now, and you will avoid having to take time off later for pain or injury. Unfortunately, because these topics are only slowly becoming integrated into our music education system, most musicians don’t recognize the need for this kind of information.

We have a long path ahead of us but it is encouraging to see increasing numbers of musicians become involved with somatics, medicine, and other modalities to improve the quality of musicians’ lives everywhere.

K: How do you plan on combining music and PT in your life?

A: This question is a work in progress. In addition to orthopedic physical therapy which is the most relevant type of PT for musicians, I am also nurturing a strong interest in neurologic PT and would like to possibly work with patients with traumatic brain injuries and spinal cord injuries. Ideally, I would like to be able to spend my days coaching and treating musicians, but also be engaged in patient care across all demographics. Physical therapy fits my wide range of interests from music, movement, fitness, education, and helping people and I want to cast my net wide. As I progress through school, this evolution will become more clear. I wish that I had discovered this path sooner, but I wouldn’t be the same caliber of musician I am, and I certainly wouldn’t have the understanding I do of musicians and the unique health challenges they face.

K: How can people find you on the internet or contact you?

A: I live in Central Pennsylvania with my husband, 3 dogs, and 5 cats. As of May 2015, I am a first year Doctor of Physical Therapy student at Neumann University. My current homes on the net are my Facebook page, twitter @sensibleflutist, and on my tumblr where I’m blogging about my DPT journey

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