[Dixielandjazz] Fw: Musician Injuries

[Bob Romans]

Any of you jazz musicians injure yourselves while playing? Or from playing
too much?
Long but interesting post.
Bob Romans

>From the Washington Post --

washingtonpost.com
Tuba Lips, Guitar Nipples and Other Musical Maladies


By Stephanie Mencimer
Special to The Washington Post
Tuesday, March 25, 2003; Page HE01


Daria White, a 19-year-old sophomore at the College for Visual and
Performing Arts at George Mason University (GMU), has been playing the
clarinet since she was 9. Since coming to college, her playing time has
increased dramatically -- and so has the pain in her wrist, up into her arm
and shoulder.

"My thumb lost feeling for several hours," she says. For a while, White
couldn't play more than 15 minutes at a time. "That really kills your
performance," she says.

She suspects the clarinet itself is to blame. The instrument weighs about
two pounds -- not a whole lot, you might think, until you hold it up for
sustained playing with only the thumb and mouth for balance. "Everyone who
does it has wrist pain," says White. She has seen a number of doctors about
the condition, including a neurologist. She's had a battery of tests, from
an MRI to painful electromyography, but the doctors can't find any
explanation for her pain. The medical advice she has gotten so far: Lay off
the clarinet. "That sent me into orbit," she says, noting that the doctors
don't understand that music is her major and future career, not just
something she noodles around with in her spare time.

White's problems are far from unusual. For years studies have shown that
musicians are at high risk for injury, especially repetitive strain injuries
that affect the small muscles in the hands. A decade ago, a doctor at the
National Rehabilitation Hospital in the District surveyed students at
Catholic University's Benjamin T. Rome School of Music and found that 76
percent of them had suffered music-related injuries severe enough to keep
them from playing for more than two weeks. Those numbers mirrored the first
landmark survey by the International Conference of Symphony and Opera
Musicians in 1986, which found a high incidence of musculoskeletal problems
among instrumentalists.

Some researchers believe those numbers have only gone up because of the
competitive nature of today's music world, and that injuries are affecting
younger and younger musicians. Washington area doctors say they see a rash
of serious injuries in kids as young as 12 and 14 after summer music camps,
where their playing time jumps to as much as eight hours a day. Hours of
practice combined with the muscle-stiffening pressures of stage fright often
take their toll on musicians' bodies, says David Sternbach, director of
GMU's Center for Arts and Wellness, who is trying to integrate injury
prevention into the university's music curriculum.

"The practice room is hazardous to your health," he says.

Don't Ask, Don't Tell
While movies often cast the geeky kid with the cello as the high school
anti-jock, playing music can tax small muscles in much the way competitive
sports strain the larger ones. Jennifer Gamboa, past president of the
performing arts special interest group of the American Physical Therapy
Association, likes to refer to musicians as "upper-extremity athletes." Says
Gamboa, "A lot of times this is a new concept for musicians as well."

Musicians' injuries are as numerous as their instruments: fiddler's neck,
tuba lips, violinist's jaw, horn player's palsy -- even guitar nipples and
harpist's cramp. The poor bagpiper is threatened by fungus that often grows
inside the instrument. And the flutist? "The flute is a biomechanically
impossible instrument to play," says Scott Brown, chief of the department of
physical medicine and rehabilitation at Sinai Hospital in Baltimore and a
musician himself.

Like athletes, musicians tend toward the "no pain, no gain" philosophy of
practice, craning chin to violin and maintaining other unnatural positions
for hours on end. Reflecting on the hand injury that derailed his legendary
concert piano career nearly 20 years earlier, Leon Fleisher told an
interviewer in 1985, "There was something macho about practicing through the
pain barrier. Even when my hand was exhausted, I kept going. Although I
thought I was building up muscle, I was, in fact, unraveling it."

Musicians admit they don't like to talk about injuries and are often
reluctant to seek medical help. Concert pianist Gary Graffman, whose career
was ended by a hand injury, wrote in 1986, "Nobody wants a wounded pianist.
There is an oversupply of healthy ones. Admitting difficulties is like
jumping, bleeding, into piranha-filled waters."

After 25 years with the National Symphony Orchestra (NSO), Milt Stevens, who
is now the orchestra's principal trombone player, has seen many of his
colleagues felled by injuries, some permanently. Yet he says that musicians
keep their ailments under wraps for fear of losing their jobs. Right now,
for instance, with rumors flying that NSO conductor Leonard Slatkin is
clearing out deadwood, Stevens says, injured orchestra members are "not
going to go running to [Slatkin] to show him what's wrong. One reason I can
talk about it is, I'm not injured."

One more reason musicians try to ignore their pain as long as possible:
They're some of the most under-insured professionals in the country. Once
they do go for help, though, musicians like White find that their
frustrations continue in the face of a medical profession that doesn't
necessarily speak their language.

Unacceptable 'Remedy'
Musicians' injuries can be difficult to diagnose and rarely show up on
X-rays or MRIs, says Brown, who is also past president of the Performing
Arts Medical Association, a national group of doctors and other medical
professionals committed to improving performers' health care. Most tend to
be lumped into the vague "overuse" category that includes other occupational
disorders like carpal tunnel syndrome. They can still be disabling.
Tendinitis in the shoulder very nearly ended the career of Max Weinberg, the
drummer for Bruce Springsteen's E Street Band.

Pianist Fleisher spent 30 years playing only left-handed concerts after
excessive practice caused the fourth and fifth fingers of his right hand to
curl under and stop functioning when he was 37. Psychiatry, lidocaine
injections, traction, hypnosis, L-dopa, acupuncture, EST -- you name it, he
tried it. Later, Gary Graffman joined him in making the rounds, seeing more
than 40 doctors.

In the early '80s, Fleisher and Graffman went public with their stories,
bringing musicians' health care needs into the open for the first time.
Until then, many doctors believed such injuries were psychosomatic -- a
byproduct of the same artistic temperament that some have linked to
musicians' high rates of substance abuse.

"The traditional medical community has not been very sympathetic to
musicians' problems," says Brown. "The usual recommendation is 'stop
playing,' " which for most musicians is simply not an option." Despite
recent progress, he says, "Arts medicine is still 20 years behind sports
medicine."

Part of the problem is that what may seem like a nuisance injury to most
people -- such as a strained pinky -- can be a career-ending disability for
a musician. Jan Dommerholt is a physical therapist who played the clarinet
and saxophone in the Netherlands' military band and now treats musicians in
his Bethesda pain clinic. He says, "Small changes can make an enormous
difference in a musician. Most health care workers don't appreciate the
complexity of what musicians do to play their instruments."

Finding a medical professional who understands musicians' special needs can
be a challenge, particularly in Washington. Daria White's clarinet
professor, Brian Jones, likens the quest to an "Underground Railroad for
musicians." While Washington is home to thousands of performers, it is one
of the few big cities that doesn't have a medical facility dedicated to
their health care, like New York's Miller Institute for Performing Artists
and the Cleveland Clinic's Medical Center for Performing Artists.

Therapy Scaled to Fit
But help is out there, and musicians say it's worth the effort to find it.
When injured musicians make an appointment to see Dommerholt, he does one
thing doctors rarely do: He asks them to bring their instruments. He checks
their posture while they play and asks about their work environments. "Do
they play in the pit and can't see anything so they slump over the music?
The physical environment of the orchestra pit is abysmal," he says. That
evaluation often shows that the instruments are the source of the problem.

Dommerholt says he had one client with myofascial pain syndrome in his
knuckles; an orthopedist told him he'd never play guitar again. As it turned
out, the man had large hands and his guitar neck was so thin that he had to
use a pincher grip to play. Once the man got a wider-necked guitar, the
problem went away.

Gamboa says another reason for seeking specialized care is that traditional
physical therapy doesn't always work for musicians. A pianist, for instance,
may have pain in the hand and wrists, but trying to strengthen the hand
muscles with weights or practice drills by Charles-Louis Hanon may only make
the pain worse. Wrist pain, she says, is usually caused by tightness or
strain in the neck or upper shoulders from bad posture.

In her Arlington studio, Gamboa tries to improve musicians' posture and then
build their strength and endurance to maintain that posture. She also works
to limit their practice time. But rather than waste her breath telling them
to stop playing, Gamboa offers a substitute -- shadow practicing -- for
example, playing piano on a tabletop.

Some musicians have also found relief from alternative therapies. Fleisher
returned to the stage with both hands in 1996, after discovering Rolfing --
a form of deep tissue massage that loosened the muscles in his forearm.
Others swear by movement training such as Feldenkrais or Alexander
techniques.

Three years ago, finger-style guitarist Nicholas Thompson, an editor with
Washington Monthly magazine, was derailed by wrist pain after playing gigs
every weekend and practicing two to six hours a day. His doctors treated him
for carpal tunnel syndrome. For 21/2 years, Thompson endured acupuncture,
steroid shots, wrist braces, massage, huge doses of ibuprofen. At work, he
tried voice-activated software, a pen mouse, typing while standing up.
Nothing helped. The last doctor wanted to operate. Thomson declined.

Recently, he moved to New York, where he saw a doctor who had treated some
musicians. The doctor referred him to an Alexander technique teacher who
completely changed the way Thompson played the guitar. The transformation
was almost instantaneous. "It seems to have cured all my symptoms," he says.

Thompson has a new CD out and is touring once more. With what he knows now,
he says, "Sometimes I watch other people perform and I think, 'Oh, my God,
you're going to get hurt.' ".

Stephanie Mencimer is a piano-playing freelance writer and a contributing
editor of Washington Monthly magazine.



© 2003 The Washington Post Company