Tag Archives: health

Health, Resources

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.

Treatment

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
Health, Resources

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
Health, Resources

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.
pain and strain
Health, Resources

Muscles in Play: Avoiding Pain and Strain

Playing is all about repetition so overuse can be synonymous with a music career. Proper posture and holding an instrument correctly are key to avoiding strain. And, because certain muscles are used repeatedly when playing, musicians should take care not to overuse those muscles during other daily activities.

If possible, hold joints in a neutral position. For example, to prevent wrist tendonitis, keep your wrist in a straight position when not playing, instead of extremely bent or flexed. This will help alleviate the added stress placed on tendons during a performance. Also, as a preventative exercise, be sure to stretch regularly.

Early intervention means you should not play through the pain. Immediate treatment is essential to prevent long-term injury. Pay attention to your pain, noting changes or increases. Encourage students to tell parents or teachers when they experience pain. Teachers should also be alert to changes in a student’s technique or style.

Tendonitis vs. Tendonosis

Naming the pain is important. Tendonitis is inflammation (redness, swelling, heat, soreness) that occurs when the immune system detects an injury and responds. The body increases the flow of blood and infection-fighting substances to the injured tendon.

Tendonosis is a degenerative injury that does not prompt an immune response. It occurs when repetitive stress over time causes the breakdown of collagen, growth of abnormal blood vessels, and thickening of the tendon’s sheath. Research suggests that many injuries diagnosed as tendonitis are actually tendonosis.

Repeated or sustained muscular contraction associated with mastering virtually any musical instrument causes a decrease in blood flow to the working muscles and tendons. In the case of overuse injuries, the body is signaled to repair muscles that are not really damaged. The result is accumulation of scar tissue in otherwise healthy muscles and tendons, which increases stress on the tendons causing them to begin to degenerate.

Scar tissue prevents normal stretching and limits muscle contraction. This can cause decreased range of motion, decreased strength, fatigue, and pain. Physicians say pain is often the last symptom. The involved muscle is then weakened, requiring neighboring muscles to overwork. This cycle of increasing stress, buildup of scar tissue, and degeneration continues until the body can no longer compensate. The result is chronic pain.

Intermission—Take a Break!

If you have an audition, concert, or festival coming up, do not rehearse all night. Spread out practice sessions. Take a break after about 45 minutes, whenever possible. Researchers say the instance of injury goes up dramatically after 45 minutes of continuous activity. Adequate rest reduces muscle tension as do proper posture and body mechanics.

Also, do not dramatically increase playing time. As athletes can attest, this presents high injury risk. An average 5K runner would not suddenly run a marathon. In the off-season, athletes cross-train. So, when not at festivals, concerts, or auditions, take time to do other activities and exercises.

Strengthen to the Core

Cardiovascular exercise and moving in general are important, especially for musicians who spend a lot of time sitting. Critical to handling, moving, and supporting instruments is strengthening other muscles: the core, upper back, and shoulders all support areas of your body used when playing.

Back pain and pain of the upper extremities are common, whether it’s shoulder pain for high string and flute players or elbow strain for violinists. Bowing techniques put strain on the right shoulder and elbow. Brass players may have back pain, consistent with having to support heavy instruments. The list goes on.

For Good Measure

Watch a video of your performance or practice to critically review your stance and playing position. Ask yourself: Do I seem to have excessive tension? Where is that tension showing up? Is it one-sided? Does it appear in my shoulders, in my hands? Do I make any extraneous movements? Do I move too much or too little?

Remember, to avoid injuries and recover from minor pains: use proper posture and body mechanics, stretch often, build your muscle strength and endurance through exercise, ramp up your playing gradually, and take frequent breaks. Always consult a physician at the first indication of pain or injury.

mental hygiene hacks
Health, Resources

10 Mental Hygiene Hacks for Creatives

What are mental hygiene hacks? Just a simple behavior that keeps your creative mind working at its very best. We list ten below.

1) Exercise 30 minutes per day to boost mood, reduce stress, sharpen your mind, and increase energy.

2) Get six to eight hours of sleep in every 24-hour period. Don’t stay in bed too long (10-plus hours dampens energy).

3) Eat healthy to boost your mood.

4) Limit substance use. Alcohol is a depressant. If you use recreational drugs or binge drink, ask yourself: Have you experienced negative consequences of your use? Are you using more drugs/alcohol or more frequently? Have you tried to stop and just keep using? Do you have cravings and withdrawal symptoms? Any positive answer is a sign you may need help.

5) Build a support system of live, face-to-face contact. Limit social media.

6) Challenge your negative thoughts. Negative bias can become a habit.

7) Self-soothe with a daily dose of sunlight. Take a walk; keep a routine.

8) Instead of listening to upsetting news, listen to music to soothe your mind. Create playlists of songs that make you happy.

9) Show compassion; practice generosity. Volunteer to help someone or care for a pet.

10) Know when and where to reach out for help. Create a core group of trusted supporters and develop a written safety plan to cope with stress.
The US National Suicide Prevention Lifeline is 1-800-273-TALK (8255). For Canada, visit the website: suicideprevention.ca/need-help/ for a list of crisis centers by province.

depression
Health, Resources

How to Talk About Depression

In the US, there are more deaths by suicide than homicide; someone takes their own life every 15 seconds. About 60% of suicides are linked to severe depression. Studies reveal that creatives, such as musicians, are more likely than the general population to suffer from depression and anxiety.

Suicide is preventable with early intervention, but those struggling with depression often withdraw. If you know someone who might be depressed, talk to them. Verbalize your concern and willingness to provide support, while encouraging them to seek professional help. Help them set up a proactive support system should they feel imminent risk of harming themselves.

How can you recognize if a friend or loved one needs help? Symptoms to look for include changes in sleep patterns or appetite, social withdrawal or alienation, mood swings, distorted self-perception, increased sensitivity, impulsivity or recklessness, and decreased coping and problem-solving skills.

Having meaningful human contact with a trusted friend can make a huge difference to someone suffering from depression. Reach out to them, making it clear that it is safe for them to tell you how they feel without fearing judgment, pity, or guilt.

What should you say:

“Hey, how are you? I mean, how are you, really?”
“I noticed you’ve been a little distant lately. Is there something you’d like to share? Would you be willing to talk about it with me?”
“I see you are hurting, and I’m here for you. I know there’s nothing I can say to fix your hurt, and I might not understand it, but I’m so grateful that you are allowing me to listen.”

What you should not say:

“If you try, you’ll feel better” or “You’re too focused on your (insert mental health ailment), you should focus on the future.”
“What’s the matter with you? Why haven’t you been (going out/calling/responding to texts/meeting up with friends)?”
“It could be worse,” and “At least you aren’t (insert bad situation)”

The New Orleans Musicians’ Clinic’s “You Got This” program provided much of the information found in this article.“You Got This” is funded by Broadway Cares.

acoustic shock
Health, Resources

Too Loud, Too Close, Too Long: Musicians Suffer Career Ending Acoustic Shock

acoustic shockIn the symphonic world, a crescendo makes for a dramatic finale, but it can have serious consequences for musicians. Recently, in an unprecedented court ruling, British viola player Chris Goldscheider, 40, won a landmark High Court judgment against Royal Opera House when he suffered career ending hearing loss from a rehearsal of Wagner’s Die Walkure. Seated directly in front of the brass section, he suffered acoustic shock, the result of sound that exceeded 130 decibels.

It’s a story that cellist Janet Horvath knows too well. The former associate principal cello for the Minnesota Orchestra, sustained an acoustic-shock injury to her left ear in 2006 after a one-time concert.

That night, the drum set, piano, electric guitars, keyboard, and conductor were positioned directly in front of her for a pops concert that included Broadway singers. Horvath was wearing musician’s earplugs, but one speaker was no more than two feet from her left ear. Eight speakers blasted music back toward the musicians. She says, “I felt it instantly; it was excruciating. When the concert was over, I took out my earplugs and could not bear to hear anyone talking. It never subsided.” She took a few months off to heal, but she needed to wear her left earplug. She compensated, relying on her right ear, and continued to be exposed to high decibels.

By 2009, her right ear, like the left, could no longer tolerate normal sound. After several doctors, she was diagnosed with hyperacusis, an auditory injury caused by repeated exposure to high decibels or a single acoustic shock. In 2010, she had to leave the orchestra that was her home for nearly 34 years.

She says, “It was characterized by abnormal sensitivity—the total breakdown of tolerance to all sound. I couldn’t leave the house. There was pain in my ear, teeth, tongue, it radiated down my neck. You actually fear sound. Many people with hyperacusis become hermits.”

The problem is prevalent, especially among woodwind players, Horvath says. “There is more awareness of the condition and I was lucky to have found physicians who helped me retrain my brain. I was fitted with special hearing aids, which turned sound down.”

“It was painstaking training that took more than two years of slowly increasing sound. I am aware of limits and decibels,” she says. Today she is mostly cured, but avoids loud restaurants and sports events. She can finally attend concerts and plays chamber music.

Noise-induced hearing loss is a combination of exposure time, noise level, peak level, and proximity to the sound. Being aware of decibel levels is important. Horvath explains, “If you know you will be playing Mahler, it’s not a day to mow your lawn.” Horvath maintains that silence is as critical to musicians as making sound. “It would be smart to have rooms where musicians can go to have silence.”

Minnesota Orchestra has an audiologist come in to offer hearing tests and fit musicians for earplugs. According to Horvath, this could be precedent-setting. No one wants to get sued so they’re now willing to take further steps to protect their musicians’ hearing. She hopes, too, that conductors will begin to alternate the repertoire to give musicians a break.

OSHA limits the number of decibels one can be exposed to per day. The decibel level of an average two-hour concert generally exceeds OSHA’s recommendations. And there are no regulations for intermittent loud blasts. Horvath adds that OSHA only talks about hearing loss as a disability when you can no longer hear speech. 

In the hall where the Minnesota Orchestra regularly performs, they have made modifications. “Our orchestra has always been on the cutting edge, partly because of my work. Their stage manager was one of the first to build a Plexiglass shield,” she says.

Horvath has written a number of books, including Playing Less Hurt: An Injury Prevention Guide for Musicians. She is a recognized authority in the area of medical problems of musicians and a recipient of the Richard J. Lederman Lecture Award presented by the Performing Arts Medicine Association. She conducts seminars across the country and regularly appears on national radio and television.

Recent News

The Mozart Effect on Epilepsy

The debate on the Mozart Effect — the notion that listening to classical music can boost brain power — remains open. Some claims from the ’90s media frenzy were debunked, yet other studies have shown evidence that Mozart’s music can improve cognition for young and old alike. Now, research from the University of Edinburgh has shown classical music benefits for children who suffer from epilepsy. A common test that detects electrical activity in the brain revealed: “there is an anti-epileptic effect of Mozart music.” Contemporary music did not have the same effect, but one 2015 study did show positive results from a classic jazz recording.

cleaning your wind instrument
Health, Resources

Cleaning Your Wind Instrument Could Be Life or Death.

cleaning your wind instrumentCleaning your wind instrument isn’t just a matter of aesthetics, it could be a matter of life or death. According to an article published in the journal General Dentistry, many woodwind and brass instruments are heavily contaminated with bacteria and fungi. Through the act of merely blowing into an instrument, you are creating the perfect warm, moist environment for germs, mold, bacteria, and microscopic organisms.

Every time an infected instrument is played, contaminants enter the lungs. If they do not cause an infection, they can cause an immune system reaction that results in inflammation of the respiratory system, and eventually, hypersensitivity pneumonitis.

In one study published in The International Journal of Environmental Health Research, Tufts University scientists tested 20 instruments and found that all of them harbored living bacteria, mold, and yeast. Wooden reeds and mouthpieces had the most contamination. While that study was focused on student instruments, there have been many well-documented cases of instrument-caused illness in adults, even professionals.

The journal Chest reported on a 35-year-old trombone player whose 15-year cough went away after he began disinfecting his instrument with rubbing alcohol. The same journal reported on a 48-year-old saxophone player with lung disease. The molds ulocladium botrytis and phoma sp. were discovered in his saxophone. 

And there’s the well-known case of English bagpiper John Shone who suffered a near fatal infection caused by fungus growing in his bagpipes. “Failing to clean my pipes led to me becoming critically ill,” he reported in Piping Times. Shone, of Wiltshire, England, who has been playing since childhood, was hospitalized twice. Doctors were stumped until they learned he was a bagpiper. They tested his instrument and discovered deadly fungi, including rhodotorula and fusarium, which typically kill half the people they infect. 

One AFM member and trombone player suffered from asthma for 15 years, until he noticed that, when he was away from his instrument, his symptoms improved. “I had a horrible barking cough—especially when I played trombone,” he explained in a 2010 National Public Radio interview. 

When doctors at the University of Connecticut, where he was teaching at the time, took a culture from inside his trombone, they found the mold fusarium, as well as a type of bacteria called mycobacterium. He admitted he was once lax about cleaning his instrument, is now diligent about cleaning. “I use a rod with a cloth and I use alcohol—rubbing alcohol or isopropyl alcohol,” he says. 

All wind instruments should, at the minimum, be swabbed on the inside after each use. In most cases, mouthpieces can be safely washed in warm water and dish soap. Brass instruments should be disassembled and thoroughly cleaned according to manufacturer suggestions every couple months, depending on use.

Health, Resources

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.