Tag Archives: health tips

Preventing and Managing Wrist Tendinitis

by Allison Shearer, MOT, OTR/L, CHT

Due to repetitive motions, instrumentalists are prone to overuse injuries of the wrist and hand. Among those most at risk are string players and percussionists. One problem is de Quervain’s tenosynovitis, a form of tendinitis particularly common in percussionists. This inflammatory condition affects the two tendons in the wrist that control the ability to pull the thumb out and away from the hand. The sheath containing the tendons swells and thickens, irritating the tendons and causing pain on the thumb side of the wrist that can extend into the thumb. Pain often worsens with thumb and wrist motion, gripping, and pinching. For professional musicians, ceasing performance usually isn’t an option. So how can you manage and prevent these symptoms?

Perform Dynamic Stretching

Regardless of whether you’re gearing up for practice or performance, always warm up. Musicians are similar to athletes. They repeatedly perform a high-level skill with extreme precision and focus. Like athletes, a five to 10-minute warm-up of dynamic stretching—stretching through motion—primes the body for playing. Moving your joints through their full available range of motion stimulates blood flow, lubricates joints, and improves flexibility, strength, and body awareness. It can also enhance performance and reduce the likelihood of injury. Try these movements to warm up your wrists and hands.

  • arm circles — Hold arms to the side of the body at shoulder height and slowly make smaller-to-larger circles clockwise, then reverse the circles to make larger-to-smaller circles counterclockwise.
  • wrist circles — Hold your fingers in a loose fist position and slowly move your wrist in a circular motion both clockwise and counterclockwise.
  • thumb opposition — Touch the tip of your thumb to the tip of each finger in an “O” shape and straight out for a stretch.
  • tendon gliding exercises for the fingers — See example images below.

Examples of tendon gliding exercises that help to warm up fingers.

Do not perform static stretching—manually stretching soft tissue and joints—prior to playing. This can actually decrease strength. This type of stretching should be saved for after you play to reduce excessive muscular tension.

Check Your Grip

Have an expert in your instrument or a clinician specializing in performing arts medicine check how you are holding and playing your instrument. For example, de Quervain’s in timpanists can be related to how you hold your mallets. Using a French style grip places extra stress on the thumb side of the wrist, irritating the tendons. With a German or American style grip, the forearm is in a more palm-down position and more force is absorbed by the palm and index finger. Modifying your grip—even temporarily—may allow you to continue playing.

Check Your Hearing

Choosing the correct type of hearing protection is essential. Too little protection can put you at risk for hearing loss. Too much protection (industrial-strength, foam-style earplugs) may cause you to “overplay.” Overplay occurs when too much high-frequency sound is filtered out and you compensate by playing louder, strumming or striking the instrument with excessive force. Specialized musicians’ earplugs provide even filtering of low, medium, and high frequency sounds.

Avoid Aggravating Motions

In de Quervain’s, the tendons are aggravated by moving your wrist side-to-side, so avoid pulling too far towards your thumb. Also avoid pulling your thumb far away from your hand—such as when stretching your hand over the top of a jar—and minimize pinching activities. This means changing the way you grasp and lift objects. For example, if you are lifting a frying pan, use a palm-up position to grasp and lift the pan to reduce stress. If you have small children, rather than picking them up by placing your hands underneath their armpits, try to “scoop” them up from underneath, again using the palm-up position.

Seek Medical Attention

If you are experiencing pain that occurs for more than four days, is unbearable, or worsening, seek medical attention. Do not let your pain become unmanageable, as early diagnosis and treatment yield better outcomes. Physicians specializing in performing arts medicine are best suited to assess your symptoms and intervene as appropriate. Participation in a hand therapy rehabilitation program with an occupational or physical therapist is often recommended.

Try Conservative Methods

After diagnosis, doctors typically recommend conservative management techniques to treat tendinitis. A recent onset (two weeks or less) of pain on the thumb side of your wrist likely means that you are experiencing acute inflammation of the tendons and sheaths. To reduced pain and inflammation during this time, apply ice for 10-15 minutes, one to three times per day or after playing. If you have significant or constant pain, you may be advised to use a thumb splint (thumb spica), which puts your wrist in a healthy position for healing.

—Allison Shearer, MOT, OTR/L, CHT, is an occupational therapist specializing in the treatment of musicians’ injuries. She is a member of the Performing Arts Medicine Association, and founder of Resonance Wellness.

When You Need It, a Safety Net with MusiCares

For the growing number of music professionals without basic medical coverage—and with the Affordable Care Act (ACA) in flux—MusiCares is a much-needed resource, which works closely with a dedicated group of health care professionals through its medical network. Services and resources cover a wide range of financial, medical, and personal emergencies. Each case is treated with integrity and confidentiality. The network also addresses human service issues that directly impact the health and welfare of the music community.

Addiction and Recovery Services

The MusiCares MAP Fund provides financial and supportive assistance for music people in need of addiction recovery services. Inpatient treatment is the first step toward long-term sobriety, but the most challenging work comes when clients leave treatment and become entrenched in their daily lives. Now clean and sober, they must manage the triggers, temptations, and lifestyle. They are again faced with bandmates or friends who are still using, schedules that are erratic, and clubs and venues that are redolent of their former lifestyles and almost daily cues to use. To assist clients in recovery, MusiCares offers a variety of free recovery support groups in many states and cities, including Los Angeles, Nashville, Austin, New Orleans, New York City, and Seattle.   

Emergency Financial Assistance

At the core of MusiCares is the Emergency Financial Assistance Program, which provides critical funds for music people struggling with financial, medical, or personal crises. This program offers financial assistance for medical expenses, addiction recovery treatment, psychotherapy, and critical illnesses. Support is also available for living expenses.

This program is available to music people who have experienced an unavoidable emergency. Eligibility consists of documented employment in the music industry for at least five years or credited contribution to six commercially released recordings or videos. Documentation can be provided in a variety of ways (liner notes, contracts, check stubs, brochures and flyers, newspaper articles, etc.). Each region has its own toll-free help line: (800)687-4227 (West Coast), (877)626-2748 (Central), and (877)303-6962 (Northeast).

MusiCares also has resources for individuals affected by natural disasters. The website has a list of resources for services, shelter, food, and other assistance. Musicians and other professionals in the music industry can qualify for housing, goods, instruments, equipment, or employment.

For more information and addiction help resources, call (800)687-4227 or visit the website at MusiCares.org.

Petty Honored as 2017 MusiCares Person
of the Year

Earlier this year, Local 47 (Los Angeles, CA) member Tom Petty was honored as the 2017 MusiCares Person of the Year. Petty was selected in recognition of his significant creative accomplishments, his career-long interest in defending artists’ rights, and the charitable work he has undertaken throughout his career, which has often focused on the homeless.

The three-time Grammy winner has been inducted into both the Songwriters Hall of Fame and Rock and Roll Hall of Fame. His approach to the music business and record making has earned him respect among his peers, as well as younger musicians coming up in the industry. He has a reputation as a musician who looks out for other musicians.

“I am so very pleased to be honored as the MusiCares Person of the Year. I have so much respect for this organization, which really does care about the people in our industry,” said Petty. “I myself know many people who MusiCares has aided in desperate situations. Again, let me say this is a true honor.”

Zika

Tracking Zika This Summer

It’s the season for outdoor music festivals with destinations that may include areas where the Zika virus has been identified. Although so far confined to a relatively small swath of the US, from Florida along the Gulf Coast to the southern-most tip of Texas, Zika is a communicable disease and is especially dangerous for pregnant women. The temperature-sensitive Aedes aegypti, the main mosquito vector, lives in high numbers in a small portion of the country, and thrives in summer months when the temperature is between 77°F and 89°F (25° C to 32°C).

The Centers for Disease Control and Prevention (CDC) has reported more than 4,200 cases of Zika, nearly all carried by travelers from other areas. But Florida reports more than 200 locally acquired cases, spread by the mosquitoes. 

Recently, Omaha, Nebraska, reported its first case of the mosquito-borne illness in a pregnant woman who became ill after a trip to Mexico in August 2016. According to the CDC, there is about a 10% chance that a fetus exposed to the virus will have birth defects, like microcephaly (an abnormally small head and brain) or developmental delays. If infected early on in a pregnancy, women can miscarry.

Zika can persist in semen and can be transmitted sexually. There is a chance that viral RNA in saliva, which never has been linked to an infection, may also pose a risk. In adults, Zika produces flulike symptoms, with little risk of more severe consequences.

Scientists have predicted Zika transmission will persist in Latin America in 2017, again with elevated US risk in central Florida, the Florida Keys, and south Texas. All of the Southern states, extending north along the Atlantic coast and into Southern California, are at risk of outbreaks. In 2015, Brazil saw more than a million cases of Zika. But the mosquitoes cannot live at elevations above 6,500 feet (2,000 meters) so the CDC recommends that pregnant women traveling to the country avoid regions below 6,500 feet.

There is no treatment or vaccine for the virus. If you are pregnant or trying to become pregnant, the CDC highly recommends avoiding travel to areas with a high risk of Zika. Before making travel plans, talk to your doctor and consult the CDC Zika travel notices.

The CDC also recommends:

  • Stay in places with air conditioning and window/door screens.
  • Use EPA-registered insect repellents that are safe for pregnant women.
  • Oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) should not be used on children under three years old.
  • DEET should not be used on infants under two months of age, according to the American Academy of Pediatrics.
  • If you use sunscreen, apply sunscreen first and insect repellent second.
  • Adults should spray insect repellent on hands and then apply to a child’s face.

Zika symptoms are usually mild, but may last for a week to several days. The average person rarely requires hospitalization. For this reason, many people may not realize they have been infected. Common symptoms of Zika include: fever, rash, headache, joint and muscle pain, and conjunctivitis. These symptoms are similar to other viruses (dengue and chikungunya) spread through mosquito bites. In countries that have had Zika outbreaks, there is a slight increase in people who have the autoimmune disorder, Guillain-Barré syndrome (GBS).

The virus usually remains in the blood of an infected person for about a week. If you develop symptoms, and if you live in or have recently traveled to an area with risk of Zika, see your doctor. Blood tests can determine the specific virus. Once a person has been infected, he or she is likely to be protected from future infection.

For additional precautions, visit: CDC (www.CDC.gov/zika/), the Florida Department of Health, Miami-Dade County (http://miamidade.floridahealth.gov), and Texas Health and Human Services (texaszika.org). The National Pesticide Information Center (npic.orst.edu) can provide advice about the safe use of insect repellents.

Proper Playing Position Is Key to Comfort and Injury Prevention in Strings

by Claire Stefani

Playing any instrument means moving a lot. Musicians make a number of physical adjustments to play, often at the expense of optimal body mechanics. Given the asymmetric position of playing a violin or viola, properly fitted ergonomic solutions are critical to a healthy body and optimized posture. It is important to find the appropriate equipment for your body and periodically check that it’s still the best solution for you. Here are some tips from a chinrest fitting expert. 

Head Balance—Keeping the head balanced and free to move is critical. Chinrest height should permit the head to rest in a neutral position at the low point of nodding “yes,” but free to move laterally (shaking the head “no”). Some chinrests provide ergonomic benefits such as additional height or left/right tilt. Some custom models allow musicians to lower their instrument and rest it partly on the collarbone in a neutral head position.

Arm Balance—If not supported by the torso muscles, arms will hang and pull the instrument downward. If a musician is not keenly aware of back and shoulder muscles, especially in the development of arm support, any attempt to adjust the chin/shoulder rest setup to counterbalance this downward weight will only put more stress on the head and left shoulder. Also, work at allowing the shoulder blade to immediately follow the humerus while shifting and bowing—similar to how the femur swings freely from the hip joint when walking.

Instrument Position—Up or down, in or out, is an individual preference. The chinrests or shoulder rests should not dictate instrument position. By allowing the instrument to lean on the collarbone, instead of only on the left shoulder, you are less likely to clench, and will have more freedom in the left shoulder, as well as in the bow arm.

Shoulder Rests—Once the head is balanced, muscular work is redistributed throughout the torso to better support arm weight, and the left shoulder is relieved from its static role, you can determine what equipment, if any, to use under the instrument. A shoulder rest can result in overall stiffening of the entire left shoulder, but playing without one can lead to distress throughout the upper body. Changes may need to be progressive. Keep in mind:

  • If a shoulder rest is too squishy, it may encourage clenching.
  • Models designed to lean just below the contour of the collarbone prevent downward pressure over the left shoulder.
  • Anti-slip surfaces may add to comfort, especially when shifting to and from high positions.

Seating—Much of your playing is likely done sitting. Wedges, pads, and stools mounted on a convex base allow a slight pelvic tilt resulting in psoas muscle release. This pelvic tilt will improve awareness of balance around your lumbar core and address lower back pain linked to postural issues or ill-fitted chinrest/shoulder rest setups.

Listen to Your Body—Pain or fatigue often come from muscle tension. It is important to identify any postural imbalance in playing position (versus neutral position)—leading muscles to sustain a static position, instead of contributing to movement. Say “No!” to the mantra “no pain, no gain.” Pain only leads to injury!

Claire Stefani is a fitter for the Frisch and Denig chinrest line, she has helped more than 400 musicians with their setup. She is founder of Volute Service International and amateur chamber music violist and violinist in New York City, an affiliate Andover trainee, and an active member of the Performing Arts Medicine Association.

Hand Pain

Relieving Hand Pain: A Drummer’s Story

by Dr. Marc Brodsky, Dr. John (Jack) Dowdle, Michele Lenes, and Joseph Corsello

drummer-hand-painRepetitive use injuries, particularly in the hands, are common for instrumentalists. Hand pain can be a result of many different ailments and musicians seeking treatment should be cautious.

Diagnoses should always be made by medical professionals. A team approach, especially consultation with specialists in musician injuries, can often provide the best treatment options. As pain can often have more than one cause, you should consider the possibility of following more than one treatment option.

Case Study

A 69-year-old professional jazz drummer had pain, accompanied by numbness and tingling, in both hands and could not bend his fingers. He experienced moderate aching pain and difficulty holding his sticks both while practicing (two to three hours a day) and during two or three gigs a week. The pain was relieved by rest and breaks from drumming, though he sometimes woke up at night with a burning pain in both hands. 

A rheumatologist originally diagnosed the problems as psoriatic arthritis, an autoimmune disease of the joints and skin. Powerful medications did not improve his condition and the pain proved debilitating. An MRI then revealed osteoarthritis resulting from overuse and general wear-and-tear of the joints.

An exam by an orthopedic hand specialist included observation of the musician playing the drums, which showed bone deformity and swelling around the middle joints of the fingers. Because the musician also had stiffness, numbness, and tingling the physician used Tinel’s test—tapping his wrists near the palm of his hands—and detected possible nerve compression in the carpal tunnel.

In the end, a hand specialist, occupational hand therapist, and integrative medicine pain management specialist were all enlisted as part of the drummer’s comprehensive treatment program.

Orthopedic Treatment 

The orthopedic hand specialist fitted the musician with hand splints for use at night, while the occupational therapist began hand therapy twice a week. Sessions included a paraffin wax dip and moist heat packs, hand massage to decrease swelling and improve mobility of the fingers, and gentle manipulation of the wrist, hands, and fingers. In addition, the therapist applied joint distractions (gentle pulling of the affected fingers). The drummer was taught hand-strengthening exercises to prevent pain recurrence.    

Integrative Approach

The integrative medicine pain management specialist performed acupuncture once a week for four weeks, gradually reducing the treatment as the musician felt relief. Treatment focused on strategic points in the neck, arms, and hands. Acupuncture is not for everyone, however studies have shown it may restore resiliency by improving circulation and reducing muscle tension and inflammation around the placement of the needles. (Always consult with your primary care physician, and find a licensed practitioner with appropriate training and credentials.)

The integrative medicine physician recommended natural anti-inflammatories, namely ginger and curcumin (found in the Indian spice turmeric). In addition, topical capsaicin, a highly purified, heat-producing component in chili peppers, was applied to the top of the hands once a day. According to the clinical studies, capsaicin depletes the amount of substance P neurotransmitter that sends pain messages to the brain. 

The Moeller Technique

The drummer modified his hand technique using the Moeller method. This technique uses gravity to do most of the work, emphasizing hand speed, power, and stick control, as well as the complete relaxation of the hand and arm muscles. Enlisting a strong downward whipping motion, the musician transitioned from pressing or gripping the drumstick predominately with the forefinger and thumb of the left hand down to the little finger. With this approach, the fulcrum is the back of the hand, allowing the other fingers to curl gently around the drumstick. This technique took pressure off the middle joints of the drummer’s hands, decreasing the risk of injury. 

By employing the above treatments and techniques, the musician had dramatic relief of his hand pain, numbness, and tingling within four weeks. In addition, he had less swelling and was able to move his fingers with greater ease. Not only that, he experienced a higher degree of function, improved sound, and an overall sense of wellness.   

Marc Brodsky, MD; John (Jack) Dowdle, MD; and Michele Lenes, OTR/L, are part of the Musicians’ Wellness Clinic in the Stamford Health System and are 2017 members in good standing of the Performing Arts Medicine Association (PAMA).

Avoid the Flu

Avoid the Flu this Season: What You Need to Know

Avoid the FluIn North America, millions of people are sickened, hundreds of thousands are hospitalized, and more than 100 million workdays are lost, due to the flu each year. It’s important to take every precaution to not have to cancel gigs. Don’t risk sidelining your career due to illness. Do your best to avoid the flu this season. 

Your best defense may be to get vaccinated. Flu vaccine effectiveness depends on how well the vaccine matches the dominant strain of influenza circulating in a particular year. This year’s shot will offer protection against the H1N1 flu virus and two other flu viruses expected this season. A vaccine that protects against four strains of the virus will be available, as will a high-dose flu vaccine for adults age 65 years and older. According to the Centers for Disease Control and Prevention (CDC), when the vaccine is well-matched, it can reduce the risk of flu by about 50%.

It takes up to two weeks to build immunity after receiving a flu shot, but you can benefit from the vaccine even after flu season is underway. Typically, the flu hits in October, peaks in January or February, and can run well into spring. Experts say that for some populations, like the elderly, the vaccine may wear off faster. But because it’s unknown when the flu will strike, it’s best for people to get their flu shots sooner rather than later.      

Who should not get a flu shot?

Check with your doctor if you have had a serious reaction to a previous flu vaccine. Generally, it’s inadvisable for these individuals.  

Most types of flu vaccines contain a small amount of egg protein. A mild egg allergy is not cause for alarm, but if you have a severe egg allergy, you should be vaccinated in a setting with medical personnel who can respond to a severe allergic reaction. There are flu vaccines approved for use in people age 18 years and older that do not contain egg proteins. Consult your doctor about your options.

What are the flu vaccine delivery options?

This year the vaccine is recommended as an injection only. The CDC no longer recommends nasal spray flu vaccinations because in the last three flu seasons, the spray has been ineffective.

The injection is usually given in a muscle in the arm. The FDA has also approved an alternative for adults aged 18-64. The intradermal flu vaccine is injected into the skin, instead of the muscle, and requires 40% less antigen than the regular flu shot.

Can the vaccine give me the flu?

The vaccine’s killed (inactivated) viruses enable the body to develop the antibodies necessary to ward off influenza viruses, but cannot give you the flu. However, you may develop flu-like symptoms—muscle aches and a fever—for a day or two after receiving a flu shot. This may be a side effect of your body’s production of protective antibodies.

It takes about two weeks for the flu shot to take full effect. If you are exposed to the influenza virus shortly before or during that time period, you may catch the flu.

What other illnesses mimic the flu?

Flu symptoms include fever, chills, malaise, dry cough, loss of appetite, and body aches. Because this is the body’s natural response to fighting infection, other illnesses mimic flu symptoms. Some of the more well-known conditions include meningitis, tuberculosis, food poisoning, hepatitis, Hodgkin’s disease, and Lyme disease.

What kind of protection does the flu vaccine offer?

The flu vaccine is generally more effective among healthy children two years old and older and adults age 64 and younger. The elderly and people with particular medical conditions may develop less immunity after receiving a flu shot.

According to the CDC, when the match between the flu vaccine and circulating strains is more precise, a flu shot is 71% effective in reducing flu-related hospitalizations among adults. The flu shot may reduce a child’s risk by 74%.

What are other ways I can avoid the flu?

Most flu viruses are not spread directly by airborne particles, like coughs and sneezes, but by direct contact. Hand washing is the first line of defense. Wash your hands often and avoid touching your face, especially your nose and eyes. Carry hand sanitizer and use it throughout the day.

Bar soap can be a breeding ground for many viruses and bacteria. When possible, use liquid soap. Hand towels should be changed frequently for the same reason. Wipe down surfaces such as stair rails, telephones, countertops, desks, music stands, doorknobs, and grocery carts. Clean your mouthpiece each time you handle it and avoid touching any part that will make contact with your lips.

Germs survive in stagnant air so open the windows and air out your home or practice room. Avoid breathing in smoke. Smoke can increase your susceptibility to viruses. If you have no choice but to play in a smoke-filled room, step outdoors for fresh air during breaks.

Rest, exercise regularly, stay hydrated, eat a nutritious diet, and try to manage your stress.

How do I determine if I have a cold or the flu?

Cold symptoms include runny nose, sneezing, and coughing. Influenza symptoms are more acute, accompanied by fever, extreme fatigue, sore throat, headache, and muscle aches.

Prescription medications, such as Tamiflu, may reduce the length of the illness, but  must be taken within the first 48 hours of showing symptoms. You can sometimes get a prescription before showing symptoms, if a family member has been diagnosed with the flu.

Although there is no cure for the flu (or the common cold), you will recover more quickly by following some simple advice. First, stay at home and rest. Try to avoid spreading the illness to colleagues and other musicians with whom you are in close contact. Physicians recommend drinking plenty of fluids and avoid alcoholic beverages, which are dehydrating.

On average, the duration of the flu is about a week. Seek medical advice immediately if you experience high or prolonged fever; difficulty breathing or shortness of breath; pain or pressure in the chest; dizziness or fainting; confusion; or vomiting.

Where can I get vaccinated?

Flu vaccines are offered at doctor’s offices. If you do not have a regular doctor or health care practitioner, you may be able to get a flu vaccine at a pharmacy, urgent care clinic, or a university  or public health center. To find a flu vaccine location near you, go to the flu shot map (http://flushot.healthmap.org/).

neck pain

Finding Relief from Neck Pain

Editor’s note: Always check with a physician if you are experiencing pain, as well as before beginning a new physical activity.

Chronic neck pain stems largely from poor posture and daily exertion. Taking simple measures to realign one’s body can decrease the odds of having to live with chronic pain. 

Our bodies are designed to work in concert with gravity. Poor posture causes a slew of problems such as inflammation, nerve compression, and limited range of motion. In some cases, it leads to acute conditions such as degenerative disc disease. If the neck is habitually thrust forward, in front of the shoulders, the pull and weight of the head places undue stress on the vertebrae of the lower neck. Our heads can weigh 10-15 pounds, which is a lot of strain. The muscles of the upper back must compensate to balance the weight. Simple stretches and exercises performed on a regular basis can offer long-term relief.

The Alexander Technique

A popular component of voice and music instruction is the Alexander Technique, which focuses on the head and spine. This correlation determines the quality of overall coordination. The exercises within this curriculum are well established and offer positive physical benefits. The approach centers on not overworking the neck muscles and the head being properly positioned and balanced, at the top of the spine. For more information, go to the American Society for the Alexander Technique at http://www.amsatonline.org/alexander-technique.

Take Care Moving Instruments

Never carry a heavy instrument with one hand or on one shoulder. For better distribution of weight, straps should be long enough to go across the chest. Use a bag or case with wheels whenever possible to transport heavier stringed instruments. Bend from the knees and keep the weight close to the body when picking up heavy equipment.

Gentle Neck Stretches

Free Up the Muscles. Let your neck muscles relax, and let your head rotate slightly forward, and go up. Slowly, and very slightly lower the tip of your nose while the crown of your head moves up. Let your sitting bones release down into the chair, in opposition to your head moving up, neither slumping nor straining. Reduce the neck tension again. Let your head rotate forward, and go up.

With practice you can release neck muscles and reduce neck tension. In time, you will realize when and how you are creating tension in your neck.

Seated Neck Release. Sitting cross-legged on the floor, or in a chair with your feet flat on the ground, extend your right arm next to your right knee or along the right side of the chair. Place your left hand lightly on the top of your head and slowly tilt your head to the left. Apply gentle pressure with your hand to increase the stretch. For a deeper stretch, hold onto your right knee or the seat of the chair. This stabilizes the torso and allows you to isolate the stretch on the side of your neck. Hold for 30 seconds, slowly lift your head and repeat on the other side.

Seated Clasping Neck Stretch. For a deep stretch for the back of your neck and your upper back, sit comfortably in a chair or on the floor. Clasp your hands and bring both palms to the back of your head. Sitting tall, ground your hips firmly into your seat. From there, begin to gently press your hands down toward your thighs, tucking your chin into your chest. As you press down, use the heels of your palms to softly pull your head away from your shoulders to intensify the stretch. Hold for at least 30 seconds, slowly lift your head and release your hands.

Behind-the-Back Neck Stretch. This standing stretch provides a deep stretch in the sides of your neck. Stand with your feet slightly apart, about hip distance, arms by your sides. Reach both hands behind your buttock and hold onto your left wrist with your right hand. Use your right hand to gently straighten your left arm and pull it away slightly. To increase the stretch in your neck, slowly lower your right ear toward your shoulder. Hold for 30 seconds and then switch sides.

For more neck stretches to reduce tension, go to http://www.arthritis.org/living-with-arthritis/exercise/workouts/simple-routines/neck-pain-exercises.php.

Lyme Disease

Lyme Disease Diagnosis and Precautions

According to the US Centers for Disease Control (CDC), Lyme disease is the fastest growing vector-borne infectious disease in the US. The number of cases has increased 25-fold since national surveillance began in 1982, now infecting some 300,000 people a year.

The disease is transmitted by the blacklegged tick and the Western blacklegged tick whose range is spreading north. The most recent surveys by CDC biologists show that they are found in more than 45% of US counties, compared to only 30% in 1998.

Once only in Ontario, Canada, Lyme-carrying ticks are now found in almost all the Canadian provinces. The Public Health Agency reported 500 cases of Lyme disease in 2014 and 700 in 2015.

Misdiagnosis

Chronic Lyme disease patients may face a long hard fight to recovery, but first it’s a battle to get the correct diagnosis. Songwriter and actor Kris Kristofferson of Local 257 (Nashville, TN) faced a diagnosis of Alzheimer’s, before he was tested and diagnosed with Lyme disease, according to recent interviews with his wife, Lisa. After many years of suffering with painful fibromyalgia, memory loss, and depression, he began aggressive treatment for Lyme disease and his health improved. Luckily, Lisa was an intuitive advocate who recognized that, cognitively, something did not add up.

The unfortunate reality is that Lyme disease often goes undiagnosed because doctors are not looking for it. Patients and physicians rely on telltale signs: a tick on the skin, the bull’s eye rash (Erythema Migrans (EM) rash), and joint pain. But research shows only 50%-60% of patients recall a tick bite, and the rash is reported in only 35%-60% of patients. Joint swelling typically occurs in only 20%-30%
of patients, and is easily masked by the prevalent use of over-the-counter anti-inflammatory medications.

Adding to the problem, people who have Lyme disease can test negative until their body builds up antibodies. Other patients can test false positive due to autoimmune disorders. The CDC recommends a two-tier testing process.

When Lyme disease is misdiagnosed during the early stages, it progresses to a chronic form that’s even more difficult to diagnose and treat. Symptoms can be debilitating, including severe fatigue, anxiety, headaches, and joint pain that mimic other conditions. Meanwhile, the disease causes complications involving the heart, nervous system, muscles, and joints. Patients may suffer through a complicated maze of specialists in search of appropriate treatment.

Treatment

If you live in an endemic area for Lyme disease and suspect you may have been infected, prophylactic treatment for at least three weeks is advised. Early treatment will prevent the body from mounting an antibody response, and subsequent testing for Lyme will be negative.

Antibiotic choice presents another host of problems. Doxycycline also treats other tick-borne pathogens, including Q Fever, and Rocky Mountain Spotted Fever. However, the parasites may carry bacteria not responsive to doxycycline. One side-effects are sun sensitivity and stomach problems. The typical 100mg twice daily dose may not reach therapeutic levels. Amoxicillin and Cefuroxime are better tolerated, but do not cover as wide a spectrum of infections.

Prevention and Precautions

Avoid tick-infested areas, especially in spring and early summer when nymph ticks feed. Adult ticks are more of a threat in fall. Ticks favor moist, shaded environments, especially leafy wooded areas and overgrown grassy habitats.

• Wear light-colored clothing to spot ticks more easily.

• Walk in the middle of designated trails.

• Wear closed-toed shoes.

• Avoid low-lying brush or long grass.

• Tuck pant legs into your socks to prevent ticks from crawling up your legs.

• Use insect repellents containing  DEET or Icaridin on skin and clothing.

• Check clothing for ticks often, then shower or bathe within two hours of being outdoors to wash away loose ticks.

While tick transmission is most common, new studies indicate that there may be other ways to contract Lyme, including blood transfusions or mosquito bites.

For a symptoms checklist go to:
www.lymedisease.org.

exercise as medicine

Exercise as Medicine for Your Music

by: Patrick Gannon, PhD

We all know that exercise is good for you. But you may not know all that exercise is good for.

Besides promoting general fitness, musicians need exercise to strengthen their legs, core, and upper body to meet the physical demands of daily practice and performance. This is particularly important because musicians are vulnerable to performance-related injuries. Exercise promotes muscle balance that offsets the physical asymmetries that commonly occur among instrumentalists. And it offers the added benefit of reducing stress.

Now, a broader recognition of how exercise impacts the mind and body is emerging. The American College of Sports Medicine, in concert with the American Medical Association, promote the idea that “exercise is medicine” to reduce risk factors for aging, diabetes, dementia, mood disorders, and sleep. Think of it as a longevity pill that is free, readily available, and has no side effects. 

Beyond being a medicine, exercise can also be a tool. The trick is to prescribe exercise purposefully to activate certain brain functions. For example, by varying the type of exercise (cardio/aerobic or weight training), as well as the intensity level (high/moderate), frequency, and timing of exercise (before practicing or performing), you can prime the brain to help with anxiety, learning, memory, mood—even creativity.

Anxiety Management

Cardio exercise may be the best natural treatment for performance anxiety, including state (situational) and trait (dispositional) anxiety. Exercise reduces anxiety by discharging muscle tension, increasing cardiovascular capacity, and disrupting negative thoughts. Physiologically, cardio stimulates the production of calming neurotransmitters such as serotonin, dopamine, and gamma-Aminobutyric acid (GABA), which dampen anxiety.

Two ways to use exercise to reduce anxiety:

1) Thirty minutes of vigorous cardio exercise will immediately reduce anxiety. Although musicians are often discouraged from exercising before performing, it can be helpful. However, the exercise must be completed at least three hours before stepping on stage, allowing sufficient time for rest.

2) For trait anxiety, ongoing exercise several times per week, for 30-45 minutes, will lower the resting heart rate.

Learning

Who would have thought that exercise could also be a learning tool? Several studies have shown that exercise improves working memory, attention, and processing speed. Exercise stimulates neurogenesis—the creation of new neurons in the hippocampus that builds capacity for learning. It also stimulates long-term potentiation (LTP) by binding neural cells together that encode learning.

Two ways to apply exercise to learning:

1) High intensity exercise (at 60% to 80% of maximum heart rate) redirects blood flow away from the prefrontal cortex (PFC), thereby inhibiting learning (recall how hard it is to think straight when pushing your physical limit). But blood flow to the PFC is gradually restored, which then optimizes brain functions for several hours afterwards. This is why exercising before practicing makes sense.

2) Combine moderate exercise (at a 120-130 bpm heart rate) with mental rehearsal of the material that you want to learn. Because exercise stimulates the brain-derived neurotrophic factor (BDNF), new neural circuits are created that encode learning. This is essentially self-directed neuroplasticity in action.

Try these exercises to promote learning and memory:

• Do 30 minutes of moderate cardio exercise while listening to the music that you want to learn or 30 minutes of high intensity exercise an hour before practicing that music.

• Divide the music up into sections and create associations to each section with your own memories, feelings, and images. These narrative links will serve as cues for memory retrieval.

• Follow up with moderate exercise while mentally rehearsing the music with the narrative imagery included. Repeat this process on alternating days until fully memorized.

Creativity

Studies show that creativity is stimulated by the interplay between the hippocampus, amygdala, and PFC. Creativity happens by holding diverse concepts in mind through working memory, using cognitive flexibility (and tolerance for uncertainty) to play with these concepts, and then focusing attention on the generation of new ideas.

Because exercise lowers the activation of the dorsolateral part of the PFC, old ideas are held back somewhat, allowing new ideas to emerge. But you must keep your mind open—and be patient with the process—until a new idea streams into consciousness.

Here’s how to exercise to stimulate creativity:

• Do 20-30 minutes of moderate cardio exercise on an elliptical trainer or stationary bike while mentally rehearsing the music you plan to practice that day. Allow new ideas to pop into awareness and then track the ideas as they unfold.

• The same technique can be applied to problem solving, procrastination, and planning. By holding the question or issue in mind while exercising, new ideas will emerge. Remember, listening to your intuition and “going with the flow” are what generates creativity.

Patrick Gannon, PhD is a clinical and performance psychologist working in San Francisco and nationally via Skype. He is a member of the Performing Arts Medicine Association and a national presenter on performance psychology. He welcomes comments and inquiries on this article. Visit his website (PeakPerformance101.com) or email him (drpatrickgannon@gmail.com).

Prevent Voice Damage

Doctor Explains How to Prevent Voice Damage

Bob Dylan never had the most beautiful voice among musician, but listening to him today it’s easy to hear his voice has gotten even coarser over the years. With the release of his newest album, Shadows in the Night, Dylan is coverings songs made famous by singers like Frank Sinatra. Not exactly the easiest songs to sing with a voice like Dylan. Seeing how getting older can affect the voice of all musicians, we’re glad Vulture reached out to otolaryngologist Dr. Milan Amin, director of the NYU Voice Center, for an explanation and more importantly, if there is any way to fix it.

Amin listened to some of the new album Shadows in the Night and compared it with Dylan’s earlier hits from the ‘60s. “The top part of Dylan’s pitch range has dropped, so he can’t access that.  When he’s trying to go up in his pitch with certain words and phrases, the voice gets rough. The other thing is that his whole tone is lower.

Amin explains that vocal cords are basically muscles underneath layers of collagen and a watery substance called hyaluronic acid. “As you get older, you lose muscle bulk. The layer starts to lose both collagen and hyaluronic acid, so the entire vocal fold sags, just like skin would. How you produce voice is by having the vocal folds come in contact with each other and blowing air past them, so if the vocal folds can’t contact each other, then you can’t produce as strong a sound.”

Amin right away points out smoking can only hurt, and being in dirty bars for so long filled with smoke certainly didn’t help either. He points out that performing on a rigorous schedule for so long will wear down the vocals. He also attributes it to late night performances, lack of sleep to rest the vocals, and even eating before bed causes acid reflux which can inflame the voice-box region.

Amin makes a great analogy comparing it to a person’s joints. “You get a little ding and they don’t work like they used to. The surface lining of the vocal cords ends up getting little nicks, so they can’t vibrate like they should.”

Luckily, and very importantly, this isn’t irreparable. Unlike most other muscles in your body where you need to use them to build strength, the vocal cords can’t do that. As Amin points out, “singers would have these huge, fat vocal chords and wouldn’t be able to breathe.”

The most common solution is simple airflow exercises and behavioral modifications to make sure they aren’t damaging their voice. There are also surgical measures, as Amin explains, “You can inject materials that will essentially give the vocal folds more body. That can give you better contact between the cords and better volume. If you give the cords better volume, they can increase their pitch range.”

For all you musicians out there, take this as a warning. Listen to Dr. Amin on how to prevent voice damage. You need to protect your voice and be careful, or you will lose it. If you have an tips to share with how your keep your voice healthy, let us know in the comments below.