Repetitive Strain Injury And The Musician - When Physiotherapy and deep tissue release matters
Musician Physiotherapy: Repetitive Strain Injury And The Musician
When Physiotherapy and deep tissue release matters
Julian Partridge is a musician who approached me to share about our management of people who acquire repetitive strain injury or injuries, specifically musicians.
he shared in his pursuit of music as a love and hobby, he acquired his
fair share of aches and pains in the past 30 years of playing musical
instruments, and upon reflections, he became "painfully aware" of the
lack of guidance he received as a young musician. He shared that he
never received education of posture, and it was by his own insight and
thinking that he started to make adjustments to the way he played. Interestingly, not many of them seek musician physiotherapy to decrease their pain and improve their conditions.
He mentioned something that reminded me of a friend. He said this:
ALL musical instruments will put a strain on the body after a period of
time. It's just that you don't notice the effects until months or years
Repetitive Strain Injury
doesn't appear overnight. They develop often after years, months or
days AFTER a repeated activity, and the thing is, it can be activities
which are loved, such as hobbies, work, or family (yes, repeatedly
lifting a newborn can cause it too, unfortunately, if not done right).
of our friends, Tat Haur, plays the violin, and he has been playing for
years. We met him at a Christian Businessmen Fellowship (BBG), and
after getting to know him, he has periodically mentioned to me that he
often has neck, shoulder, hands and finger cramps and aches. Often too,
he asks me to provide him relief, and I found that trigger point therapy and clinical massage therapy provided him a lot of muscular relief.
palpation and touching of his affected muscles, I found that he has
very taut and shortened muscles in his affected areas, namely the neck
muscles, the upper back muscles, his left shoulder, his elbows, forearms
and fingers of his left hand (as he's a violin player, he developed
repetitive strain injury on his left side, where the violin sits on his
left side of his chest, neck rotated to the left and clamps on the
violion, left hand sustained in a slightly flexed shoulder, flexed
elbow, flexed wrist and repeatedly flexed and extension fingers as he
played the violin). A perfect combination for massive repetitive strain
injury - classic musician physiotherapy case.
As I spoke with him more and more, he shared
with me his training and preparation routine, which packed a whopping
>20 hours per week in that position (not to mention the intensity +
frequency + duration) as emotions go roller-coaster or as the instructor
increases or decreases the pace.
is, the musicians whom I speak to will term repetitive strain injury as
"the price to pay for love of music" and then not do anything more about
it DURING the practice or tournament, so that leaves us to work on
relieving and preventing AFTER the training and tournaments.
you're a musician, regardless of if you're a beginner or a veteran,
here's some tips and techniques to identify, manage and prevent the
development of repetitive strain injury in musicians, on top of seeking professional musician physiotherapy input.
- Know the symptoms:Short
bursts of severre cramping, excruciating pain in the arm, back,
shoulders, wrists, hands, or thumbs (typically diffuse – i.e. spread
over many areas); pain worsens with activity; and weakness, lack of
endurance. This book on Repetitive Strain Injury helps.
- Ergonomics with an experienced musician physiotherapy specialist to
test and find out the best body posture that provides you the most
relief, least stress or pain, and the bare minimum frequency and/or
duration of micro-breaks that you require (for the musician who puts
music first, those who wants to take care of their bodies more, the best
amount of rests lies in a 10 seconds break every 15 minutes). Or, find a
modified version of the instrument that best suits your body size and
- Take a micro-break: rest and stretch every 15-30 minutes
- Pharmaceutics: such as NSAIDs (non-steroidal anti-inflammatory drugs) and painkillers to eliminiate pain. I personally used Aleve Liquidgels Pain Reliever before, and they worked for me. *Note,
these eliminate pain but that doesn't mean that there's no injury being
dealt to the body EACH time you play, so it'd be best to keep this in
- Musician Physiotherapy and Splinting
to rest the body part with repetitive strain injury. Braces and
splinting are by far, the mostly used products for repetitive strain
injury (as many musicians I know prefer non-invasive, non-oral treatment
approaches). Some of these braces and splints can be bought in your
local pharmacies, but if you find that they don't fit, look for a hand
therapist or occupational therapist who can custom make one for you in
your town or country. We're located in Singapore, so if you're in
Singapore, we'll be happy to help. Splints provide the best resting
position for two main functions - firstly, optimal positioning for
optimal healing, and secondly, immobilization + protection from internal
or external forces. If you're looking online, try Mueller splinting
- Exercise prescribed by our musician physiotherapy specialists can work wonders for our patients with repetitive strain injury. To
understand how this works, we must first see the patient as a whole
person, and not just an injured body part etc. Then we can see that a
patient may have weaker back, which causes a "slump" and the body then
overcompensates the "slump" with a more tightened position, accelerating
development of repetitive strain injury at a particular site.
the time, by treating a weaker spot, a particular injury may lessen in
pain occurrence and intensity as the body functions better as a whole.
Also, a healthier and fitter body has better overall body functions, and
able to take much more physical demands as compared to one which is
- Choosing The Right Music Teacher:
from a clinical perspective, Julian is mindful to educate, teach and
prevent the development or aggravation of repetitive strain injury in
his students. Choose a teacher who shares a similar mindset.
- Going On Despite The Pain:on
one hand, we respect pain that any patients experience, on the other
hand, we cannot allow the pain to takeover a patient's life and
determine their routine (of course, this needs to be determined by a
medical professional or the physiotherapist managing the patient with
repetitive strain injury) - patients are required to continue with their
daily routine, just more paced out, and avoid activities that directly
aggravate their injuries, to prevent a "pain-aversive mindset", which
will result in long term complications later.
factors which includes stress management, anger management issues, if
any, as stress and anger can cause and contribute directly, to the
development, aggravation and sustained repetitive strain injury.
approaches to managing RSI. Honestly, any body parts will have the
severe excruciating pain when/if it undergoes consistent, repeated and
sustained exercise and activity, as when muscles elongate and contract,
they create a by-product called lactic acid from the energy used in the
movement. A pooling of this lactic acid causes the cramps and
contractions, and if it pools too much and not removed effectively,
consistent pain and cramps will result. Patients are informed of this,
that they will have a rational perspective on the pathophysiology of
their repetitive strain injury, so as to not allow stigmatization or
demonization of their injuries and hand use.
- Warm Up before playing or practicing.
- Musician Physiotherapy for treatment.
- Regular deep tissue release and sports massage to regularly release the shortened and tightened muscles will help to normalize muscle function, increase blood circulation and loosen trigger knots for increased performance.
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