Musicians' Health Collective

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

Filtering by Tag: overuse

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.     


Focal Dystonia Resource Guide

After an excellent American Viola Society festival last week in Los Angeles, I'm still processing the panels, discussions, and performances.  One session in particular was about managing neurological conditions as a performer, including focal dystonia, which is something that musicians often fear.  I've previously interviewed a musician about focal dystonia, and written about it, but I think it's good to revisit this material, both as performers and educators.

Focal Dystonia Resources.jpg

In addition, the image is available as a PDF for download.

Your Overtaxed Eyes and What to do About Them

Generally, we think of overuse as applying to large muscle groups and in relationship to pain sensations, i.e., I played too much this weekend and my forearms/shoulders/back hurt.  But what about our eyes?  Just as our larger muscle groups can be overtaxed, our eyes can as well, especially when we're constantly engaged in work close to our face.  Most of us are looking at sheet music, books, computers, and phones for many hours a day, which keeps the ciliary muscles contracted and our eyes engaging in things close up all of the time.

As a side point, I am a fortunate person in that I have perfect vision.  My dog, however, has cataracts and has dealt with glaucoma, so I've had a crash course in canine opthalmology courtesy of her treatment.

As a side point, I am a fortunate person in that I have perfect vision.  My dog, however, has cataracts and has dealt with glaucoma, so I've had a crash course in canine opthalmology courtesy of her treatment.

*Quick time out, the ciliary muscles are the middle layer of eye muscle and change the shape of the lens of the eye.  Here's a more science-rich quote from David Darling in response to the role of the ciliary muscles:

When the ciliary muscle is relaxed the ligaments are taut, and the lens is stretched thin enabling it to focus on distant objects. When the ciliary muscle is contracted the suspensory ligaments become less taut, and the lens becomes rounder so that it can focus on objects that are nearby.

The contraction and relaxation of the ciliary muscle is controlled by the autonomic nervous system. Sympathetic nerve fiber stimulation (see sympathetic nervous system) causes relaxation of the muscle, whereas parasympathetic stimulation (see parasympathetic nervous system) causes muscle contraction. The ciliary muscle is part of the ciliary body.
— David Darling

  When most of us use our eyes only in a close distance (2-20 feet), our eyes never have a chance to relax.  Add to that dubious lighting either for reading music (in a pit, in orchestra, etc.) and no wonder your eyes are tired!  Our eyes thrive on seeing both near and far, and in order to see objects far away, the ciliary muscle must relax fully.  So what can you can do to facilitate an eye reset?

1. Try to go outside and truly observe the landscape, both near and far, side to side, etc.  See how much you can allow your eyes to move without moving your head to facilitate peripheral viewing.  In addition, walking outside (as opposed to treadmill walking) changes the impact to the eyes (optic flow) because you are moving in relationship to objects, with objects starting far away and coming nearer.

2.  Notice if you're overusing your phone, i.e., doing emails and substantial work on your phone.  The small text, the bright light, and the proximity to your face isn't helping things, especially if you're on it more than necessary.

If you're always engaging with sheet music from one side of the stand (AKA. sitting inside or outside) your vision will also change. 

If you're always engaging with sheet music from one side of the stand (AKA. sitting inside or outside) your vision will also change. 

3.  If you're in an ensemble rehearsal, take a moment at breaks or before rehearsal to look into the depth of the hall or rehearsal space and then come back to the music.  If your eyes are feeling particularly overworked, spend more time looking into the seats or outside into the landscape. 

4.  If you're desk bound for most of your day, take a few moments to look out of a window every hour or so, not only to get in some natural light, but also to give your eye muscles a chance to change the loads and stresses placed upon them. 

Also take note- can you see better from one eye or from one side of the stand (if you're a string player) than the other?  Do you have one sided headaches, jaw pain, or neckaches after playing that correlate to vision distortion?  Poor alignment can certainly contribute to vision strain, so be mindful of your position seated and standing.  If you're a wind player or singer, also keep in mind that your eye pressure (aka. intra-ocular pressure) may spike in response to your instrument, so if you're receiving treatment for cataracts or glaucoma, do tell your opthalmologist about your occupation. 

To read more about overtaxed eyes, check out Katy Bowman's

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