Musicians and Injuries

Perhaps there have been long rehearsals for that crucial recital, and now you notice stabbing pains in your forearms. Or you find yourself struggling with hands that have become increasingly clumsy, or numb. It may be that you are even waking up at night with pain in your arms, or your back, or your neck. Well, it's just a part of being a serious musician, right? And after all, you can't stop practicing - there's too much at stake, and music is your very life! Instrumental musicians are at a very high risk for injuries because of repetitive motion. If they are also computer users, it doubles their chances of getting injured.

These are some of the most typical injuries:

Carpal tunnel syndrome, tendonitis, bursitis, tenosynovitis, tendonosis, deQuervains syndrome, trigger finger/thumb, thoracic outlet syndrome, myofascial pain, loss of hearing, temporomandibular joint disorder, syndrome. Incorrect posture, non-ergonomic technique, excessive force, overuse, stress and insufficient rest contributes to chronic injuries that can cause great pain, disability and the end of careers.

There are two main types of injuries which can happen to drummers; over-use injury and traumatic injuries. If you have a serious condition or a condition which has failed to improve in two to three weeks, you need to seek professional health care.

Achilles Tendon

Drummers can develop pain behind their ankles from repetitive motion that happens from playing single or double bass. The Achilles tendonitis can be acute or chronic. The Achilles tendon is the large tendon at the back of the ankle that connects the large calf muscles to the heel bone.

It doesn't matter if you are playing heel up or heel down, the Achilles tendon is in constant motion. The Achilles tendon shortens or contracts to push the foot down while playing with the heel up and it stretches when the foot lifts off the pedal in the heel-down position.

The main reason the Achilles tendon becomes inflamed is from overuse. However, there are other contributing factors. The Achilles tendon has a very poor blood supply which explains why it is very vulnerable to injury and takes a while to heal.

Symptoms of Achilles tendonitis are simply pains in that tendon during everyday activities. The pain will get worse with prolonged exercise and agitation but it will go away with adequate rest. Swelling is common and may be associated with redness over the skin. You might even feel a creaking noise when you press on it or move your foot.

Chronic Achilles tendonitis can often occure from acute Achilles tendonitis if not treated properly. It is hard to treat, especially in older people. In acute Achilles tendonitis the pain might go away after a warm-up but will return when you have stopped. Eventually the pain becomes so severe that it is difficult to walk and even impossible to run.

The first line of treatment for Achilles tendonitis is of course rest. A cold wrap for 15 minutes at a time is extremely helpful. In the early stages of Achilles tendonitis it is very helpful to wear a felt heel pad to raise the heel and relieve some of the strain off of the tendon. This should only be used as temporary measure while the Achilles tendon is healing. Stretching exercises for the Achilles tendon is very crucial. Physical therapy is only needed for those cases that did not respond to early treatments. Nonsteroidal anti-inflammatory medications are also beneficial.

Tendonitis

Tendonitis is a term which is used to described an "inflammation" of the tendon and its covering/sheath. Although it is yet to be proven conclusively that there is indeed inflammation of the tendon, it has come to be know as an inflammatory condition. The general thinking is this: When the tendon and its covering are irritated, overloaded or frankly damaged, the tissues swell up and begin the process of healing. If the swelling constricts the motion of the tendon through its sheath, pain and loss of motion occur. At the same time, fluids and tissue cells and debris build up in the area. This can lead to further irritation.

Elbow Epicondylitis

The elbow has a bony process on the inside or medial region and on the outside or lateral region. This region comes under great stress from due to the action of the tendons and fascia which pass on or near the area. If the area becomes inflamed it may not fully resolve. In this case a chronic elbow pain can result. Stretching and ice to the area can help prevent this problem. If the area does become chronically involved seek treatment from a qualified provider. Treatments of value may include heat, friction massage, ice, specific stretching and exercises or ultrasound therapy.

Neuritis

Irritation or infection along a nerve can create a condition where the nerve tissue becomes "excitable". If this occurs, pain and loss or distortion of sensation, taste, sight, smelling (olfaction) or hearing can occur. In drummers this can occur in the wrists, fingers, elbow shoulder or neck. Proper symmetrical technique, good ergonomics and warm up can limit irritation of the peripheral nerves in the arms, hands and fingers.

Carpel Tunnel Syndrome

Within the wrist pass the nerve, arteries and veins which control and feed the hand and fingers. There is an anatomical tunnel on the underside (palmar surface) of the wrist through which the median nerve passes. The median nerve controls motion and carries sensation to the thumb and 2nd finger. It is important to remember that the nerve pathway begins at the neck and passes into the arm through the thoracic inlet. (compression of the neurovacular bundle in the inlet is referred to as thoracic outlet syndrome) The health of any of the nerves which supply the arms and hands is dependant upon uncompromised function through the entire length of the nerve. Compromise by subtle compression due to inflammation or hypertension of the musculature can occur in the neck, the shoulder the elbow the forearm or the wrist. For this reason, many professionals prefer to treat the entire nerve pathway if it is found that there may be areas of compromise. Proper stretching of the wrist, forearms, fingers, shoulders and neck can help to lessen the possibility of carpel tunnel like conditions. Such stretches are also critical in the proper treatment of these conditions.

Sprains

Sprains refer to the tearing or over stressing of the ligaments of the body. The classic example is a sprained ankle. In a sprained ankle the ankle rolls over, forcing the ligaments on the outside of the ankle well beyond their usual range of motion. If this occurs the ligament tears. The down side to this is that ligament and all soft tissues of the musculo-skeletal system heal with scar tissue. Scar tissue is less elastic and more pain sensitive than the tissue it replaced. (Bone on the other hand heals with bone. That is why we often say it is better to break a bone than sprain a ligament) Use of ice as soon as possible after a sprain is critical and can cut the healing time by as much as 50%!

Strains

Strains refer to soft tissue injuries to tissues other than the ligaments. Muscles, tendons and fascia are examples of soft tissues which strain. In a muscle a strain is often referred to as a "Pull". As with many soft tissue injuries, strains can be prevented by proper condition, stretching and nutrition. If you have sustained a muscle strain, ice the area at once for 7 to 10 minutes until numb. Use ice over the next 2 days 3 or 4 times per day. Ice helps lessen swelling and blooding and speeds recovery time. Depending on the extent of the injury you may require professional evaluation of the condition.

WHAT TO DO

INFORM YOURSELF get familiar with causes and prevention.

EVALUATE YOUR TECNIQUE find postures that keep your joints in the middle of their range of motion. Use larger muscle groups when possible.

ALWAYS WARM UP enough said here.

TAKE BREAKS AND STRETCH constant tension and repetitive motion does not allow the body to flush away metabolic waste products and this is traumatic to tissues over time.

PACE YOURSELF prepare for concerts, attend music camps, and get heavily involved with music groups. All of these can radically increase our playing time and exceed the limits of our body. Learning to pace ourselves and learning to say no sometimes, is critical.

EVALUATE OTHER ACTIVITIES Your problems may be caused or aggravated by other things you do frequently. Computer use is a notorious example, but sports, carrying children, hobbies, and excess effort/tension in other daily things may have an impact too. do. Computer use is a big problem.

PAY ATTENTION TO YOUR BODY pain is your body screaming that it has had enough.

CHECK YOUR INSTRUMENT check to see if your drum kit is set-up properly. Set your kit to you, not you to the kit.

BE CAREFUL WITH STRENGTHENING METHODS - Building up muscle strength with special devices or musical exercises is very touchy. If you're already injured and in pain, such things may make it worse. Overdoing musical exercises while using bad technique, poor posture, or too much force will only make it worse. If you're not injured yet, or undergoing therapy, properly conditioning muscles may help prevent injury or re-injury. Be patient in building strength, and talk to a qualified doctor or physical therapist.

GET MEDICAL HELP - Therapists and doctors know that musicians are hard to persuade to reduce or stop their playing to allow injuries to heal, and some instructors may tell students to ignore pain, or accuse them of trying to avoid practice. But "No Pain, No Gain" is a bad policy for a musician. If it hurts, back off.

Ear Plugs

An Important Accessory for Drummers and Other Musicians

Sound levels are measured in decibels. Decibel is logarithmic unit, so that an increase of 10 decibels means a sound wave has 10 times more energy. Using a deibel meter, It was measured, hitting a snare drum as hard as practical without trying to puncture the drum head. The sound level was 126 decibels, which is almost as lound as a jackhammer, but of course not continuous like a jackhammer. More measurements indicated that normal playing during rehersal with an electric guitar and bass exposes you to about 100 to 110 decibels of noise.

According to the Occupational Safety and Health Administration, which is the US government's agency responsible for setting work safety standards, any sound of 85 decibels or above can be potentially harmful, depending on the duration of exposure. Sounds above 140 decibels might lead to hearing loss, no matter what the duration of exposure. A 90 decibel sound can lead to hearing loss if the exposure is for 8 hours or more per day. Beyond 90 decibels, the length of time is cut by half for every 5 decibel increase in sound level. For 110 decibels in most rehersals, it's 1/2 hour.

Ear plugs cut down noise levels by about 20 decibels, so this brings exposure down from 110 decibels to 90, which is good for 8 hours. Even if the ear plugs are off by 5 decibells, 4 hours per day is still within safety margin. Stuffing tissue paper or cutton in your ears will reduce noise by about 7 decibels, which is good for less than 1 1/2 hours play time, not counting the incidental super loud snare drum or crash cymbal hit.

The exposure times mentioned above do not guarantee hearing loss, but can lead to it. You might hear fine for 20 years of noise exposure, but then one day notice that you have trouble hearing, or worse yet, other people will start telling you that you don't hear what they are saying. And there will be nothing you'll be able to do about it then, so start wearing ear plugs now.

References:
WebMD