Tag Archives: health

dental checkups

Keep Your Chops and Get Dental Checkups

Teeth grinding. TMJ. Muscle cramps. Dry mouth. Cold sores and calluses. These are all potential problems for wind and brass musicians, who can often suffer from pathological conditions that are aggravated by their occupation. Repetitive movements, excessive practice, and stress can cause a number of dental and orofacial problems.

It is not uncommon for musicians to experience TMJ (temporomandibular joint pain), muscle strain, or focal dystonia (failure of a muscle to respond). As the result of continuous playing—and with age—tooth and mouth structure can shift. Tongue position and muscles of the lip and cheek are vital for embouchure. Dentures and dental implants, soft palate pain, cracks in teeth caused by vibration, and loss of feeling or sensitivity in the lips all can interfere with performance level.

Know Your Dentist

Eventually, controlling pitch and tone can become problematic. The slightest change in the position of the tongue or shape of the teeth (which occurs over time and with age) can alter airflow and change embouchure. Clearly, regular dental visits are highly recommended, but it’s important to entrust dental care and treatment to dentists with expertise in conditions that specifically affect musicians. With consistent care, they can provide relief and help prevent further problems. Bring your mouthpiece for a better overall assessment.

Teeth that are sensitive to cold become more sensitive from inhaling air. Desensitizing toothpastes will help manage the problem, but your dentist may also discuss applying bonding resin to sensitive root surfaces. To strengthen enamel, fluoride treatments may be recommended.

Over time, mouthpieces can also cause irritation. To slow down wear and tear, appliances can be made to help cover the upper incisors and evenly distribute the pressure. For teenagers under the age of 15, playing for several hours a day may cause the upper teeth to protrude, which may require orthodontia. Keep your dentist or orthodontist informed of any changes you feel in playing technique.

In Sync

Science and technology have come a long way in crafting advanced, precise mouthpieces. Likewise, adaptive mechanisms may include lip shields, treatments to improve occlusion (bite), or customized mouthpieces for trumpet players. In fact, some practitioners recommend taking the instrument to the dentist’s office at the time of consultation. This allows the dentist to better assess problems and, if necessary, to create a prosthetic appliance tailored to your specific need.

Wind players should consider having a model made of their dental arches every year. It’s an inexpensive way of safeguarding their sound. A specialist would know that wind instrumentalists display complex neuromuscular activity during performances. For instance, an exam would be complemented with the aid of technology to better understand orofacial structure and the embouchure mechanism. Any prosthetic rehabilitation would provide minimal changes to the musician’s performance.

Warm Down

For single reed players, where much of the weight and pressure is on the lower jaw, the biting surface of your lower teeth may slowly wear away and/or chip. In double reed players, there is increased risk for pain and calluses. The increased pressure in the mouth may increase the risk of infection within the ducts that release saliva.

The pressure on teeth for double-reed and brass players forces teeth inward. Brass players can also suffer from trauma to the upper lip. A long night of playing, when teeth are in direct contact with the mouthpiece, can lead to dental wear and tooth fracture, and lip trauma. Experts recommend not only warming up before a gig but also “to warm down” afterwards—playing long tones, scales, and lip slurs—to prevent chop problems. Playing puts pressure on the embouchure, which may become inflamed. The warm-down helps a musician regain that pliability. Above all, if there is an injury, practice the three Rs: Rest, Recuperation, and Rehabilitation.

carpal tunnel

Piano Playing and Preventing Carpal Tunnel Syndrome

by Brent Wells, D.C.

For piano players, the possibility of developing carpal tunnel is a real concern. Most people who play the piano, professionally or as a hobby, play every day or multiple times per week. While this is a great way to get better at the craft, it also means that your chances of suffering from this syndrome increase. That is because carpal tunnel develops when you use your hands in the same repeated motion.

However, just because you are at an increased risk for developing carpal tunnel syndrome, it does not mean there aren’t things you can do to prevent it. While there is no surefire way to ensure it does not happen, you can reduce the likelihood.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is both a simple and complex issue. It occurs when your median nerve squeezes and compresses at your wrist. This nerve is located in your forearm and connects to your hand’s palm.

carpal tunnel
Carpal tunnel develops when you use your hands in the same repeated motion. If you begin to develop carpal tunnel, the ligaments in the area grow thicker, which causes a narrowing of the tunnel. When it narrows, your median nerve will begin to compress and squeeze, creating pain and other symptoms.

The carpal tunnel is made of different bones and ligaments that creates a narrow tunnel at the base of your hand. This tunnel helps bend your fingers and allows sensation in your palm and fingers—except your little finger. It also controls some smaller muscles in your thumb.

These areas of the hand are exceptionally important for playing the piano since you need fine tune motor skills to play effectively.

If you begin to develop carpal tunnel, the ligaments in the area grow thicker, which causes a narrowing of the tunnel. When it narrows, your median nerve will begin to compress and squeeze, creating pain and other symptoms. Some of the most common symptoms of this syndrome are:

  • Burning
  • Tingling
  • Itching
  • Numbness
  • Swollen feeling in the fingers
  • Useless feelings in fingers

Even though your fingers may feel swollen, they are not swollen in appearance. Symptoms develop over time and get worse gradually. You will begin to feel the above issues in the fingers and the palm and symptoms may appear in one hand or both.

As the condition progresses, you will find it challenging to grip objects and move your hands normally. Since playing the piano almost solely relies on your ability to move your fingers, hands, and wrist in a precise and graceful way, developing carpal tunnel can be devastating to your career or hobby.

How to Prevent Carpal Tunnel Syndrome

Before any symptoms start, you can incorporate
the following into your
weekly routine:

  • Keep your wrists straight.
  • Sit up straight.
  • Shake out your hands.
  • Stretch your hand, fingers, and wrists.

For more stretches and strengthening exercises to help prevent carpal tunnel, read the helpful article at WebMD, “What Exercises Help for Carpal Tunnel Syndrome?

What to Do When You Feel the First Symptoms

carpal tunnel
Some of the most common symptoms of Carpal Tunnel Syndrome are burning, tingling, itching, numbness, swollen feeling in the fingers, and useless feeling in the fingers.

According to a 2009 study in the International Symposium on Performance Science, which analyzed both men and women pianists with carpal tunnel, the authors found that a delayed diagnosis of carpal tunnel resulted in two ways. Either surgery was needed or the fear of diagnosis and possibility of surgery lead to late diagnosis and prohibited early treatment. 

This study suggests that the fear of diagnosis and the potential for surgery means many people do nothing about symptoms when they first appear. If you let your symptoms progress without intervention it will become worse, hence surgery is more often necessary. However, with early intervention, less invasive treatments often were administered and doctors were able to effectively treat symptoms without surgery.

These findings show us that early treatment is imperative to quick recovery and stopping the progression of the syndrome. The key to preventing carpal tunnel syndrome is to immediately seek treatment when you feel symptoms.

In the end, remaining in-tune with your body will be the best tool for preventing carpal tunnel. At the first signs of an issue, speak with your doctor in an effort to stop symptoms before they even start. Maintaining proper form and doing stretches and exercises will also go a long way for prevention. 

Dr. Brent Wells, D.C. is the founder of Better Health Chiropractic & Physical Rehab and has been a chiropractor for over 20 years. His practice has treated thousands of patients from different health problems using various services designed to help give you long-lasting relief.

Dr. Wells is also the author of over 700 online health articles that have been featured on sites such as Dr. Axe and Lifehack. He is a proud member of the American Chiropractic Association and the American Academy of Spine Physicians. And he continues his education to remain active and updated in all studies related to neurology, physical rehab, biomechanics, spine conditions, brain injury trauma, and more.


Our Brains Appear Uniquely Tuned for Musical Pitch

In the eternal search for understanding what makes us human, scientists found that our brains are more sensitive to pitch, the harmonic sounds we hear when listening to music, than our evolutionary relative the macaque monkey. The study, funded in part by the National Institutes of Health, highlights the promise of Sound Health, a joint project between the NIH and the John F. Kennedy Center for the Performing Arts, in association with the National Endowment for the Arts, that aims to understand the role of music in health.

“We found that a certain region of our brains has a stronger preference for sounds with pitch than macaque monkey brains,” says Bevil Conway, Ph.D., investigator in the NIH’s Intramural Research Program and a senior author of the study published in Nature Neuroscience. “The results raise the possibility that these sounds, which are embedded in speech and music, may have shaped the basic organization of the human brain.”

The study started with a friendly bet between Conway and Sam Norman-Haignere, Ph.D., a post-doctoral fellow at Columbia University’s Zuckerman Institute for Mind, Brain, and Behavior, and the first author of the paper.

At the time, both were working at the Massachusetts Institute of Technology (MIT). Conway’s team had been searching for differences between how human and monkey brains control vision only to discover that there are very few. Their brain mapping studies suggested that humans and monkeys see the world in very similar ways. But then, Conway heard about some studies on hearing being done by Norman-Haignere, who, at the time, was a post-doctoral fellow in the laboratory of Josh H. McDermott, Ph.D., associate professor at MIT.

“I told Bevil that we had a method for reliably identifying a region in the human brain that selectively responds to sounds with pitch,” says Norman-Haignere. That is when they got the idea to compare humans with monkeys. Based on his studies, Conway bet that they would see no differences.

Tuned for Musical Pitch: NIH-funded scientists found that our brains may be uniquely sensitive to pitch, the harmonic sounds we hear when listening to speech or music. Image: Courtesy NIH

To test this, the researchers played a series of harmonic sounds, or tones, to healthy volunteers and monkeys. Meanwhile, functional magnetic resonance imaging (fMRI) was used to monitor brain activity in response to the sounds. The researchers also monitored brain activity in response to sounds of toneless noises that were designed to match the frequency levels of each tone played.

At first glance, the scans looked similar and confirmed previous studies. Maps of the auditory cortex of human and monkey brains had similar hot spots of activity regardless of whether the sounds contained tones.

However, when the researchers looked more closely at the data, they found evidence suggesting the human brain was highly sensitive to tones. The human auditory cortex was much more responsive than the monkey cortex when they looked at the relative activity between tones and equivalent noisy sounds.

“We found that human and monkey brains had very similar responses to sounds in any given frequency range. It’s when we added tonal structure to the sounds that some of these same regions of the human brain became more responsive,” says Conway. “These results suggest the macaque monkey may experience music and other sounds differently. In contrast, the macaque’s experience of the visual world is probably very similar to our own. It makes one wonder what kind of sounds our evolutionary ancestors experienced.”

Further experiments supported these results. Slightly raising the volume of
the tonal sounds had little effect on the tone sensitivity observed in the brains of two monkeys.

Finally, the researchers saw similar results when they used sounds that contained more

natural harmonies for monkeys by playing recordings of macaque calls. Brain scans showed that the human auditory cortex was much more responsive than the monkey cortex when they compared relative activity between the calls and toneless, noisy versions of the calls.

“This finding suggests that speech and music may have fundamentally changed the way our brain processes pitch,” says Conway. “It may also help explain why it has been so hard for scientists to train monkeys to perform auditory tasks that humans find relatively effortless.”

Earlier this year, other scientists from around the US applied for the first round of NIH Sound Health research grants. Some of these grants may eventually support scientists who plan to explore how music turns on the circuitry of the auditory cortex that make our brains sensitive to musical pitch.

lyme disease

Summer is Coming, Remember to Protect Yourself Against Lyme Disease

When it comes to health, the fear of any musician is contracting a disease or condition that impedes or even prevents the ability to make music. Imagine suffering from severe fatigue or anxiety, chronic muscle spasms or joint pain, constant headaches and sensitivity to sound and light—and having no clue where it came from, what it is, or even how to effectively treat it. Unfortunately, this happens all too often with the continued rise in Lyme disease cases throughout North America.

With the arrival of summer, it is a good time to review and remember the threat that Lyme disease poses to anyone who steps outside. For musicians who may spend hours at outdoor rehearsals and performances, the risk is important to keep in mind.

lyme disease

According to the U.S. Centers for Disease Control (CDC), the incidence of Lyme disease in the United States has approximately doubled since 1991, increasing from 3.74 reported cases per 100,000 people to 7.95 reported cases per 100,000 people in 2014. An estimated 300,000 people are infected with the illness annually.

Lyme disease is a bacterial illness transmitted through the bite of a deer tick. Most people are infected through the bites of tiny, immature ticks called nymphs, which most commonly bite during spring and summer. In the majority of cases, the appearance of a rash resembling a bull’s eye or solid patch, about two inches in diameter, appears and expands around or near the site of the bite.

According to the CDC, early stage symptoms of the disease include fatigue, chills and fever, headache, muscle or joint pain, and swollen lymph nodes. People treated with oral antibiotics such as doxycycline or amoxicillin for early Lyme disease usually recover quickly. If Lyme disease is unrecognized or left untreated during the early stage, however, more serious symptoms may occur including acute fatigue, a stiff aching neck, tingling or numbness in the arms and legs, or even facial paralysis. The most severe symptoms of Lyme disease may not appear until weeks, months, or years after the tick bite. These can include severe headaches, painful arthritis, swelling of the joints, and heart and central nervous system problems. This requires a longer duration antibiotic therapy treatment.

lyme disease

Unfortunately, one of the major battles of Lyme disease sufferers is first getting the right medical diagnosis. Doctors often are not looking for Lyme disease and patients may not realize they have it by either not recognizing the rash for what it is, or by masking the usual symptoms through the use of over-the-counter pain and anti-inflammatory medications.

One of the more well-known cases of celebrity Lyme disease in recent years was that of songwriter and actor Kris Kristofferson of Local 257 (Nashville, TN) who suffered ailments for years—and was given a diagnosis of Alzheimer’s—before he was tested and diagnosed with Lyme disease. Other musicians who contracted Lyme disease and have gone public with their suffering and how the illness has affected their career include Deborah Gibson of Local 802 (New York City), Shania Twain, Avril Lavigne, Daryl Hall, and Pete Seeger.

The best way to prevent Lyme disease is to take precautions when spending time outdoors. Ticks favor moist, shaded environments, especially leafy wooded areas and overgrown grassy habitats. If you are recreationally moving about in tick-infested areas, the most common advice from health organizations such as the CDC and National Institute of Allergy and Infectious Diseases is to 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, and tuck pant legs into your socks to prevent ticks from crawling up your legs.

But what if you are a musician performing at or attending an outdoor venue where you have a stricter dress code, and perhaps long grass or other potential tick habitats are unavoidable? The CDC also recommends using insect repellents containing DEET or Icaridin on skin and clothing and be sure to check your body for ticks when you get home (under the arms, in and around the ears, inside the belly button, back of the knees, in and around the hair, between the legs, and around the waist). It is also important to shower or bathe within two hours of being outdoors to wash away loose ticks. According to medical experts, if a tick is attached to your skin for less than 24 hours, your chance of getting Lyme disease is extremely small.

For more information about Lyme disease and preventing Lyme disease, visit www.lymedisease.org.

better hearing month

Prick Up Your Ears: May Is Better Hearing Month

better hearing month

May is National Better Hearing Month and the American Academy of Audiology encourages everyone to make an appointment with an audiologist if they suspect hearing loss for themselves or their loved ones. The American Speech-Language-Hearing Association (ASHA) designated May as Better Hearing and Speech Month in 1927 with the goal  of raising awareness about speech and hearing challenges and encouraging people to treat their hearing and speech problems.

According to the National Institutes of Health, National Institute on Deafness and Other Communications Disorders (NIH NIDCD), approximately 20% of American adults aged 20 to 69 (48 million) have some trouble with hearing and approximately 28.8 million could benefit from the use of hearing aids. Among adults aged 70 and older with hearing loss who could benefit from hearing aids, fewer than one in three has ever used them.

As the baby boomer population ages, more Americans are forced to face hearing health challenges. Growing numbers of younger Americans (including millennials and Gen Xers) are also reporting hearing problems. The NIH NIDCD also states that five in 10 young people listen to music or other audio too loudly and that four in 10 young people are around “dangerously loud noise during events like concerts and sports games.” 

Occupational noise is another factor impacting hearing in people of all ages who work outdoors, in factories, fulfillment centers, and in music.

Professional musicians are almost four times as likely to develop noise-induced hearing loss (NIHL) as the general public, and they are 57% more likely to develop tinnitus—incessant ringing in the ears—as a result of their job, according to a 2014 study published in British Medical Journal. NIHL can be caused by a sudden loud noise, such as an explosion or gunfire, but it may also develop gradually as a result of repeated exposure to loud noise, according to the authors of the study. Over time, loud sound will irreparably damage the hair cells of the inner ear, which are sensory receptors responsible for sending sound to the brain.

Musicians need to remember to pay attention to their surrounding sound levels, not just during performances, but also during practices and rehearsals. Not only does every instrument have a different decibel level, but it is important to understand that certain instrumental sections tend to produce higher sound levels. Sometimes these levels relate to the piece of music being performed and to notational requirements (fortissimo); other times, these levels naturally resonate from the instrument. According to information from the Eastern Kentucky University School of Music, string sections tend to produce decibel levels on the lower end of the spectrum, while brass, percussion, and woodwind sections generally produce decibel levels at the higher end of the spectrum. It is important to be mindful of the overall volume of your instrument and of those around you.

Signs of hearing loss include:

•   Having to turn up the volume of the television, radio, or stereo and having other family members complain that the volume is too loud.

•   Difficulty understanding people speaking to you and asking people to repeat themselves.

•   Difficulty with phone conversations and understanding the other person.

•   Sudden inability to hear the doorbell, the dog barking, and other household sounds.

•   People telling you that you speak too loudly.

•   Ringing in the ears.

The American Academy of Audiology suggests that musicians, especially, should get a hearing test to establish baseline hearing levels because they are exposed to loud music on a regular or semi-regular basis. Ask to be tested on a range of 125 to 20,000 hertz, as the highest frequencies often show loss first. If you’ve had ringing in your ears, consider including a tinnitus assessment.

According to the Center for Hearing and Communication, continued exposure to noise above 85 dBA (adjusted decibels) over time will cause hearing loss. According to the National Institute for Occupational Safety and Health, the maximum exposure time at 85 dBA is eight hours. At 110 dBA, the maximum exposure time is one minute and 29 seconds.

Points of Reference measured
in dBA or decibels
Sound Levels of Music in dBA
(Courtesy of Eastern Kentucky
University School of Music)

0 Softest sound a person can hear   
with normal hearing
60-70 Normal piano practice
10 normal breathing70 Fortissimo singer (3 feet away)
30 soft whisper75-85 Chamber music, small hall
40 quiet office, library84-103 Fortissimo piano
60 normal conversation82-92 Violin
80 alarm clock85-111 Cello
110 shouting in ear95-112 Oboe
120 thunder92-103 Flute
125 pain begins90-106 Piccolo
140 firecracker (peak)85-114 Clarinet
90-106 French horn
85-114 Trombone
106 Tympani and bass drum
120-137 Symphonic music peak
120 Amplified rock (4-6 feet away)
150 Rock music peak
performance stress

Dealing Effectively with Performance Stress

Don Greene
Peak performance psychologist and author Don Greene, PhD.

by Don Greene, PhD

During my 35-year career as a peak performance psychologist, I have helped countless performing artists learn how to perform their best under pressure. My clients have won major auditions and competitions all over the world. I have never met a performing artist who has not felt some kind of performance stress. Whether they call it nerves, stage fright, or performance anxiety, the stress comes from fear—fear of how it will go, fear of how people perceive them, fear of not performing at a high enough level, and so on. My goal is to help performers break down this fear and to give them tools to combat it.

When musicians encounter highly stressful situations they tend to react instinctively. It does not matter whether something is really threatening their safety or if it is just a perceived threat (like an audition panel or an angry conductor). The perception of potential harm triggers the part of the brain known as the limbic system or emotional (not rational) mind.

If you are like my clients, you have felt yourself getting nervous at an audition or performance. Your limbic system responds to your nerves by releasing adrenaline into your bloodstream, which triggers physical changes. Within nanoseconds, the heart starts to race and respiration increases. You become very alert and your senses become extra sharp. You start to feel shaky as you scan your environment for danger. Your muscles tighten and you begin to sweat. Sensing the extra energy surging through your system, your mind goes into overdrive. You may begin obsessing about the potential results and feel things like dread, self-consciousness, self-criticism, loss of focus, and confusion.

If a real danger was present, you would be ready to fight for your life or run away at record speed. But for many musicians, the physical and mental changes caused by this flight/fight response deteriorate their normal performance skills. The goal is to learn to use this extra energy to your advantage.

There are several things you can do to prevent your nerves from progressing out of control. First, figure out what your most common symptoms of performance stress are: racing heart, shakiness, butterflies, perspiration, cold limbs, racing thoughts, dry mouth, or unfocused mind, for example. Then, start keeping track of your sleep, food, hydration, and preparation level before stressful performances. Adequate sleep helps quiet and focus the mind. Try to limit or eliminate caffeine, sugars, alcohol, and heavy meals. Proper hydration helps with dry mouth, jet lag, and adjusting to changes in climate for traveling performers. Feeling prepared always boosts confidence and, in turn, helps decrease performance stress symptoms.

Next, learn to accept that you may feel nervous. You can expect to feel a huge rush of energy before important performances or auditions. Instead of viewing adrenaline as a negative thing to overcome, you should use it to your advantage by channeling it into the music. The energy will allow you to deliver exciting, intensely focused, and powerful performances that can move audiences and sway audition panels. Start to practice performing with that extra energy.

Set up your instrument and music, then turn on a recording device in a room. Step out of the room and do something to get your heart rate up like jumping jacks or run a flight of stairs. When your heart is pounding, enter the room and pick up your instrument. Take a slow, deep breath and relax the muscles that are actively involved in your playing. Ignore your racing heart and focus on what you need to do. Shift to your right brain by hearing the first phrase just the way you would like it to sound. Then, without hesitation, let it fly with reckless abandon, riding the extra energy that you feel. Stop after the first few phrases and turn off the recording device. Do not listen to the recordings until you’ve completed the exercise five to seven times. By then, you’ll get the idea and be ready to listen to your progress. You will have practiced performing your best with at least some of the symptoms you feel when you are under real pressure.  

My centering method is another great tool to help channel the mental and physical effects of performance stress into powerful performances.

Author of Fight Your Fear and Win and Performance Success, Don Greene is the first sports psychologist to teach in a music conservatory. He has helped thousands of musicians win auditions and major competitions. Based in Los Angeles, he also works with clients remotely. Visit the website winningonstage.com for information about Greene and his online centering courses.


Fiber Is Key: Diverticulosis Requires Diet and Lifestyle Management

Diverticulosis is a condition in which small bulging pouches form in the lining of the digestive tract, usually in the lower part of the large intestine or sigmoid colon. Occasionally, one or more of the pouches become inflamed or infected—in which case it becomes diverticulitis, indicating an infection. An acute attack can cause severe abdominal pain, fever, nausea, and bowel irritability. Mild diverticulitis can be treated with rest, changes in diet, or antibiotics. Severe or recurring diverticulitis may require surgery. For musicians, whose careers revolve around tours, eating on the road, and sitting for long periods, diverticulosis requires vigilance.

In general, unless they have an attack, many people do not know they have diverticulosis. It is often detected incidentally, through routine colonoscopy. If this is the case, it’s important to know the symptoms of an episode, which include pain in your lower abdomen, tenderness, bloating, and cramps. If you have been diagnosed with diverticulosis, it’s advisable to enlist a gastroenterologist and see a dietitian for food recommendations.

An episode of diverticulitis may start out mild, but left untreated or unmanaged, it can escalate quickly. Subsequent episodes may become more severe. Fever is a clear indication of infection (diverticulitis), which can lead to more serious problems, such as peritonitis (caused by perforations in one or more diverticula); abscess in the abdomen; or obstruction (blockages of the intestine). 

During the active stage of the infection, physicians recommend eating a low-fiber diet and drinking plenty of water. Once the infection clears, and on the recommendation of your doctor, fiber should be back on the menu.

Uncomplicated Diverticulitis

See your doctor if you have any symptoms. If it’s a mild case, she or he is likely to recommend:

•   Antibiotics to treat infection, although new guidelines state that in very mild cases, they may not be needed.

•   A liquid diet for a few days while the bowel heals. Once symptoms improve, gradually add solid (though low-fiber) food to your diet.

•   An over-the-counter pain reliever, such as acetaminophen. This treatment is successful in most people with uncomplicated diverticulitis.

Management of Ongoing Diverticulosis

According to the American Society of Gastrointestinal Endoscopy (ASGE), diverticulosis affects half of everyone over 60 years of age in the US, though it’s rare in people under 40. As a person ages, the pouches (diverticula) in the digestive tract become more prominent. In addition, it is uncommon in certain parts of the world, such as Asia and Africa, where diets are high in fiber and rich in grains, fruits, and vegetables. For this reason, most health practitioners believe the condition is due, in part, to a diet low in fiber. A low-fiber diet leads to constipation, which increases pressure in the sigmoid colon. 


Vigorous exercise appears to help lower the risk of diverticulitis. A low-fiber diet, combined with a high intake of animal fat, will likely increase the risk. While it is recommended that we consume 20 to 35 grams of fiber daily, most people only get about half that amount.

Eating vegetables and whole grains is a starting point for managing diverticulosis. Drinking plenty of water helps the body capitalize on the fiber. Doctors often recommend supplemental fiber. There are plenty of on-the-go options as well. Fiber and protein bars can supplement for days on the road when you cannot work in proper meals or regular exercise.

General guidelines include minimal use of alcohol (which dehydrates), getting regular exercise, and maintaining a healthy weight. A sedentary lifestyle is a risk factor. Desk jobs and sitting for too long are generally unhealthy: stand up every hour—move around, stretch, take a short walk. Try to fit in moderate-to-vigorous exercise during the day, like a brisk walk or a run.

Adopt a High-Fiber Diet

The best sources of fiber are fruits, vegetables, legumes, and whole grains:

•   Beans, such as black beans, kidney beans

•   Brown and wild rice

•   Fruits, all kinds, fresh and dried, raw or cooked

•   Vegetables of all kinds, raw or cooked

•   Whole grain breads, cereals, and pasta


If you have received a diverticulosis diagnosis, your doctor may also recommend that you add the following to your daily diet:

Fiber supplements: to ensure adequate fiber intake and to prevent constipation

Probiotics: as a possible measure for preventing diverticulitis

Should you avoid nuts, popcorn, and seeds?

Historically, the advice for people with diverticulosis was to avoid nuts, popcorn, corn, seeds, and seeded fruits and vegetables for fear that seeds would become trapped in the diverticula, causing inflammation. This advice is no longer considered valid. In fact, these foods are a good source of fiber. Do your research and speak to your doctor about optimal fiber intake. Also, if you have been diagnosed with diverticulosis, consider talking with a dietitian about general food guidelines for management to prevent an attack of diverticulitis.

If you have symptoms of diverticulosis or diverticulitis, you should seek immediate treatment from your healthcare provider.

Musician’s Dystonia Symptoms and Treatment

Dystonia is a neurological movement disorder that occurs when the brain sends incorrect information to the muscles. It is characterized by failed or involuntary muscle contractions and movements. Focal dystonias affect specific parts of the body—neck, eyes, face, vocal cords, hands, and feet.

Scientists have not been able to determine an exact cause for focal dystonia. It seems to be related in some way to repetitive motions because it occurs most frequently in musicians who have intensely practiced their instruments over a number of years. It is often focused in the body part where the most complex movement patterns are performed. There is a genetic predisposition in only about 5% of cases.

Focal hand dystonia is strikingly more common in musicians than other groups of professionals that require intricate hand movements—dentists, surgeons, writers. According to the Dystonia Medical Research Foundation, 1%-2% of professional musicians are affected by dystonia, though many may be undiagnosed. At first, they may perceive symptoms as faulty technique or insufficient preparation. Dystonia may even be misdiagnosed as a psychological condition.

Instrumentalists with dystonia commonly exhibit symptoms in the following ways:

  • Pianists: right hand, 4th and 5th fingers
  • String players: left hand
  • Guitarists: either hand, 3rd finger of right hand
  • Percussionists: either hand
  • Woodwinds: either hand, face, mouth
  • Brass players: corners of mouth, jaw

By far, the two most common types of focal dystonia affecting musicians are embouchure dystonia and hand dystonia.

Focal Hand Dystonia

Focal hand dystonia typically manifests as loss of muscular control in highly practiced movements and can also be accompanied by tremors. Initial symptoms include subtle loss of control in difficult passages, lack of precision, involuntary curling or sticking of fingers, and involuntary flexion of the bowing thumb. The problem is almost always painless and task specific. For example, with doublers it may only occur on one particular instrument, but not the other. It may also be sensitive to sensory input with some pianists reporting symptoms only when playing on ivory keys (not plastic).

Embouchure Dystonia

This type of dystonia is most common in brass and woodwind players. It may affect muscles of the mouth, face, jaw, and tongue. Symptoms may be subtle at first—air leaks at the corners of the mouth and tremors (sometimes worse in higher registers) or involuntary and abnormal contractions of the face muscles.


There is currently no cure for dystonia, so the focus is on treatment. Sometimes anticholinergic drugs that affect the transmission of messages from the brain to the muscles can help. Botulinum toxin injections can compel the body to create new programs by blocking nerve impulses to contracting muscles. They work by temporarily weakening the muscles so the spasm is reduced and therefore are a better choice for hand dystonia than embouchure dystonia.

The ultimate goal of treatment is to establish new sensory motor programs to accomplish the tasks that have become challenging. Altering posture or key positions could help. Sensory tricks, like playing while wearing a latex glove or stimulation applied to affected areas, can lessen symptoms. Sensory re-education attempts to reverse the changes in the cortex that have caused the dystonia through repetitive exercises and/or visualization.

In sensory motor retuning (constraint induced movement therapy) nonaffected fingers are immobilized in a splint while performing repetitive coordination exercises. This may facilitate freer, more independent movement patterns from a dystonic finger.

Dystonia can be a symptom of other serious conditions. If you are experiencing uncontrolled muscle movement or contractions see your doctor as soon as possible. For more information on musician’s dystonia visit the Dystonia Medical Research Foundation (www.dystonia-foundation.org/musicians).


Biomechanics: How to Be In Sync with Your Instrument

An important yet often neglected component of performance is proper biomechanics. Technique, skill, and interpretation all contribute to a musician’s professional potential, but the physical toll of holding an instrument and playing it for hours puts a strain on the musculoskeletal system. What’s more, the stress can result in debilitative injury. According to Alexandra Türk-Espitalier, a flutist, physiotherapist, and researcher at the University of Music and Performing Arts Vienna, it’s often when a musician reaches the point of physical discomfort that physical conditioning takes center stage.

In her book, Musicians in Motion: 100 Exercises with and Without Instrument, Türk-Espitalier compiled 100 exercises to correct misaligned playing posture and relieve playing-related pain and overuse syndrome. She has carefully designed a system of training and exercise, zeroing in on the source of the pain and addressing issues with exercise, strength training, and specific routines for different instruments.

Body Awareness, Breathing

According to Türk-Espitalier, who has worked with many orchestras and virtuoso solo performers in Europe, problems can be corrected, even for longtime professionals. Through an analysis of movement and posture with the instrument, a number of problems can be pinpointed: misalignment; muscle tone dysbalance; lack of flexibility, strength, and coordination; or faulty playing technique. She tailors specific relevant exercises for musicians to promote endurance, expression, and pain-free playing.
Instrumental technique correlates to body regions and awareness. Deep breathing and long airflow are directly related to the lower spine. Hip joints should be open and the torso stabilized with an upright pelvis. Big sound and fast articulation require a free neck, flexible eyes, free ears, and flexible lower jaw. For precise key touch you need light and long arms, wide chest and collarbone, and free and flexible shoulders.

Alignment and Exercise in Daily Life

Musicians are used to focusing on instrument-specific coordination, but practicing correct body alignment of joints and achieving muscle balance should extend to everyday activities. Türk-Espitalier notes that prevention should be designed according to strengths and weaknesses. To identify them, observe others and get feedback from professionals. To achieve a holistic outlook on your music with and without your instrument—and above all, to prevent injury—incorporate a training schedule that includes physical conditioning.

It’s a challenge, says Türk-Espitalier, for musicians to “dissolve” and replace old habits. “Faulty patterns have been practiced for many years and are, therefore, firmly embedded into movement, playing technique, and behavior. If basic movement patterns have to be relearned, I recommend a time when few concerts are scheduled.” Trying to resolve problems during a busy season can be difficult. She says, “Great care must be taken to ensure that a musician’s quality of playing is not diminished and the player does not become frustrated.”

Her book is comprehensive, from causes and bad habits to warmup, cool down, and breathing. There are solutions for almost every problem. Structured according to areas of the body and the associated physiological stress factors, the routines are easy to follow. For flutists and violinists, there are shoulder and arm exercises. Tension in the forearms, hands, and wrist can be reduced effectively with massage—the palm of the hand, the thenar, and the hypothenar. For instance, with cellists, massaging the thenar muscles of the right hand is recommended. The exercises are suitable for professional and recreational musicians alike.

Younger musicians are more tuned into instrument-specific fitness regimens. Türk-Espitalier says, “In Germany, Switzerland, and Austria, music physiology is now even a mandatory subject at some music universities.” She explains that the younger generation of professional musicians is more familiar with the concept and uses the techniques to enhance their playing skills. She views musicphysiology as a critical component of performance—playing with ease and pain free in a competitive industry.

Türk-Espitalier has worked with individual members of most of the major orchestras in Germany and Austria (Vienna Philharmonic, Frankfurt Radio Symphony Orchestra, WDR Orchestra Cologne, and more). She has conducted orchestra-wide workshops throughout Germany.

Alexandra Türk-Espitalier, PhD, is a flutist, physiotherapist, researcher in music physiology, and lecturer at the University of Music and Performing Arts Frankfurt and at the University of Music and Performing Arts Vienna, where she is program leader of a postgraduate certificate course in music physiology.

motion sickness

For Some Traveling Musicians Motion Sickness Goes with the Territory

If you are on the road this festival season, hopping on and off planes, or more likely, the tour bus, there’s a good chance you might have a bout of motion sickness. The queasy stomach and nausea are a result of the disparity between the visual and vestibular systems (the latter of which constitutes the inner ear and is responsible for balance and equilibrium).

Normally, these systems work in concert to integrate information. Motion sickness occurs when the inner ear detects movement, but the eyes do not register movement. Scientists call this “sensory conflict.” In a plane, the eyes tend to adjust to the movement as if you are barely moving. Your inner ear, which is lined up with the terrestrial environment, reacts to the actual movement in relation to gravity. The eyes and inner ear are sending conflicting information to the brain. These mixed signals and subsequent imbalance cause nausea and vertigo, often accompanied by vomiting. Some doctors recommend reducing and/or shutting down signals by removing offending smells, tastes, noise, and vision. So, high-quality earplugs and an eye mask may help.

Sea Sickness and Visual Input: On a Boat, in a Plane

When someone reads in the car, they reduce the visual input of motion because they are not looking ahead or out the window. The vestibular system notes movement, but it’s not aligned with the visual signal. We see that we’re moving by looking out the window and we sense the motion via our vestibular system. In a vehicle, sit in the front seat and lean your head against the headrest to minimize head movements. Research suggests that focusing on a distant point on the horizon helps realign the senses and the brain. For some people, driving the vehicle, rather than being a passenger, is an instant remedy.

If you’re a landlubber, but suddenly find yourself a gig on a cruise ship, choose a lower-level cabin in the middle of the ship, which generally experiences less motion. Standing topside, focusing on the horizon helps one regain balance. Hence, getting your sea legs. Leaning back and keeping head movements to a minimum may reduce the number and complexity of signals to the brain. Numerous products are available, including anti-seasickness wristbands (acupressure and magnetic), which work by applying pressure to points located on the underside of the arm.

In a plane, request a window seat and look out the window. A seat over the front edge of the wing, where the degree of motion is lowest, is preferable. Direct the air vent to blow cool air on your face. Use the seat headrest to stabilize your head. On a train, always face forward and sit near a window. Recline your seat slightly, resting your head.

According to Chinese medicine, acupressure can balance the chi or flow of energy in the body. Some people who use acupressure on their wrists report reduced motion sickness. A 2017 study from the National Center for Biotechnology Information (NCBI) showed that electroacupuncture could also reduce susceptibility to motion sickness.

Talk to your doctor if you think you need medication for motion sickness. Commonly used over-the-counter medications are diphenhydramine (Benadryl), dimenhydrinate (Dramamine), and scopolamine. As some of these medicines cause drowsiness, follow the labeled warnings if you plan to operate a vehicle.

General tips to prevent and ease symptoms:

  • Get a good night’s sleep before traveling.
  • Eat a light, high protein meal beforehand. (Avoid heavy, greasy, and acidic foods. Coffee, citrus juice, heavy meats, and carbs are slow to digest.)
  • Drink plenty of water. Do not drink large amounts of alcohol before you travel. Alcohol dehydrates and generally lowers resistance to motion sickness.
  • If possible, stand if you feel queasy and look out over the horizon.
  • Do not read or use mobile devices while traveling, if you are prone to motion sickness.
  • Open a vent or source of fresh air, if possible.