Tag Archives: health

Vertigo
Health, Resources

When Vertigo Rocks Your World

Vertigo

Vertigo is a tilting, spinning sensation of being off-balance. You may feel like the world is spinning around you even when you are standing perfectly still. Vertigo symptoms are caused by a disturbance to equilibrium, and may be accompanied by nausea and headache. More than 2 million people visit their doctors each year complaining of dizziness or vertigo, and while it’s generally a harmless symptom, you can imagine how it could be debilitating and stop a performer in her tracks.

To better understand the cause of vertigo you need to look at the anatomy and function of the ear. Sound waves travel through the outer ear canal until they reach the eardrum. There, sound is turned into vibrations, which are transmitted through the inner ear via three small bones (the incus, malleus, and stapes) to the cochlea, and finally to the vestibular nerve, which carries the signal to the brain. A collection of semicircular canals (canalis) positioned at right angles to each other inside the inner ear act like a gyroscope for the body. These canals, combined with sensitive hair cells within the canals, provide us feedback regarding our position in space. When there is a disturbance in this system, it can cause vertigo.

Common Types and Causes of Vertigo

  • Benign paroxysmal positional vertigo (BPPV): This type of vertigo is caused by tiny calcium particles (canaliths) that clump in the canals of the inner ear, which sends signals to the brain about movements relative to gravity to keep your balance. This type of vertigo is most commonly felt when tilting the head or climbing in and out of bed.
  • Meniere’s disease: This inner ear disorder is thought to be caused by a buildup of fluid, which alters the pressure in the ear. Along with vertigo, symptoms can include ringing in the ear (tinnitus) and hearing loss.
  • Vestibular neuritis or labyrinthitis: This inner ear problem is caused by an infection (usually viral). The infection inflames the inner ear around the nerves that are important for helping the body sense its balance.

Less frequent causes of vertigo include head or neck injury, brain problems (stroke or tumor), certain medications, and migraine headaches. In many cases vertigo will go away with no treatment. When necessary, what treatment is used depends on the cause of the vertigo.

Common Treatments

  • Canalith repositioning maneuvers: Performing a series of specific head and body movements can relieve the symptoms of BPPV by shifting the calcium deposits out of the ear canal and into an inner ear chamber where they can be absorbed by the body. While the movements are safe and effective, you may need a doctor or physical therapist to teach you the techniques. Also, if you are uncertain which ear is affected your doctor can let you know.

—Epley maneuver is the most common, and provides relief to 90% of BPPV sufferers.

1) Sit on the side of your bed. Turn your head 45 degrees to the side of the affected ear (not as far as your shoulder).

2) Quickly lie down on your back, with your head on the bed (still at a 45-degree angle). Place a pillow under you so it rests between your shoulders rather than under your head. Wait 30 seconds.

3) Turn your head halfway 90 degrees in the opposite direction without raising it. Wait 30 seconds.

4) Turn your head and body on its side in the same direction, so you are looking at the floor. Wait 30 seconds.

5) Sit up slowly but remain on the bed for a few minutes.

6) Repeat before going to bed each night until you’ve gone 24 hours without dizziness.

     —Half somersault or Foster maneuver

1) Kneel down and look up at the ceiling for a few seconds.

2) Touch the floor with your head, tucking your chin so your head goes toward your knees. Wait about 30 seconds or until any vertigo stops.

3) Turn your head toward the affected ear. Wait 30 seconds.

4) Quickly raise your head so it’s level with your back while you’re on all fours. Keep your head at that 45-degree angle. Wait 30 seconds.

5) Quickly raise your head so its fully upright, but keep your head turned to the shoulder of the side you’re working on. Then slowly stand up.

6) Repeat this a few times for relief, resting for 15 minutes in between.

  • Vestibular rehabilitation: This physical therapy may be recommended by your physician if you have recurring vertigo. It is aimed at helping to strengthen the vestibular system and its function in sending signals to the brain about head and body movements relative to gravity.
  • Medication: In cases where vertigo is caused by an infection or inflammation, antibiotics or steroids may reduce swelling and cure the infection. For Meniere’s disease, diuretics may be prescribed to reduce fluid build-up pressure. In some cases, medications are taken to relieve the nausea associated with vertigo.

Occasionally vertigo can be a symptom of a more serious problem. It’s always advisable to visit your physician when you are experiencing any medical condition.

Health, Resources

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.”

IEMs
Recent News

Safe Sound in an Age of Living Loud: Correct and Safe Use of In-Ear Monitors

IEMsIn a loud stage environment, musicians become accustomed to hearing their monitor mix at high volume. Some use in-ear monitoring systems (IEMs) to reduce the impact, but if the volume on the device is not regulated and lowered, it’s no solution. IMEs are only considered protective devices if they are used at safe levels.

IEMs are in demand because they isolate the ear from ambient noise and artists can hear the intended signal clearly, at a much lower volume. Critical to the equation, though, says Michael Santucci, Au.D., a researcher and expert who specializes in hearing conservation, is much lower volume. It requires modifying user behavior and listening patterns.

Look no further than the iPod. Studies have shown, in case after case (especially with teenagers), that there was irreversible damage because of volume and prolonged listening. Do most musicians use ear protection? “No,” says Santucci, “Are attitudes changing? Absolutely.” 

It’s like sun exposure, he explains: it’s both how strong it is and how long you’re exposed. In music, it’s personal susceptibility, how loud, and how many hours you’re in it. “We do pit crews for Broadway plays. Is it terribly loud? Not always, but they’re doing it six hours a day.” Nowadays, Santucci frequently works with orchestras because they are featuring more pop stars. The added decibel (dB) quotient can be deafening to orchestra members. Santucci says, “Risk goes up with volume and length of exposure.”

A recent study out of Vanderbilt University showed that, regardless of whether they used floor wedges or IEMs, subjects turned them up to their usual listening level. Everybody had three days of in-ear and three days of floor wedges at different times and in different venues. Every musician turned to exactly the same loudness every day.

“If you’ve been practicing guitar for years at 110 dB with wedges, the natural tendency will be to turn your IEMs to 110 dB, even if it’s not needed,” Santucci says. “And until the audiologist says you need to turn it down to here, their brains tell them to go back to the level they’re used to.”

The good news is that the second part of the study showed that musicians can recalibrate their brains to listen at a lower level. After a couple of weeks, it becomes the norm. Santucci says, “It’s habit—like the timbre of your instrument, pitch—it’s all because you’ve done it a million times. Loudness goes right along with it.”

Adding Ambient Sound

Some musicians say they feel disconnected from the band and the crowd with IEMs. This can be addressed in a few ways. The trick, Santucci says, is to do so without compromising the isolation of the IEM system. A simple remedy is for the sound engineer to set up audience mikes to add to the monitor mix so the artist can get a feel for the room. “Some musicians take out one IEM, which is very damaging to hearing. They end up turning up the side with the ear monitor even louder, plus they have an open ear not protected by anything.”

For a natural, but more robust, method of adding ambient sound into the IEM mix, Santucci recommends 3D active ambient IEM systems that allow the musicians to control how much ambient sound is heard. “What I do not recommend is porting the earphone to let ambient sound leak. Porting effectively eliminates the benefits of isolation and cannot be controlled, it has the potential for the user to turn up the volume of the system to unsafe levels.” 

Safe Listening

For hearing conservation benefits of in-ear monitors, refer to OSHA and NOISH guidelines to determine exposure times for safe use. Shows of less than one or two hours are less of a problem. For a club band, whose shows may go on for several sets of three or more hours, volume levels must be much lower and should average no more than 95 to 97 dB.

The problem is being able to accurately determine the decibel level coming from the in-ear monitors. Currently, the only method to measure these levels is with ear-probe microphone technology used during rehearsals or sound checks by an audiologist. From these readings, a volume level can be recommended based on the length of a show.

Tinnitus and Hearing Loss

If your ears ring or if you have trouble hearing after a concert, you are definitely in danger of noise induced hearing loss (NIHL). Santucci cautions, “Even if your ears don’t ring, if you think it’s safe, you’re wrong. Research shows that, of those suffering from NIHL, only 30% experienced ‘ringing’ as a warning sign. In other words, if your ears ring after a performance, you’re too loud. But if they don’t ring, there’s a 70% chance you may still be damaging your ears, if levels exceed OSHA safe exposure limits.”

For additional information, visit the websites: www.osha.gov/SLTC/noisehearingconservation or www.cdc.gov/niosh.

Other Hearing Protection Tips:

  • Invest in superior hearing protection,
    custommade ear molds with dampening filters.
    Preferably use musicians’ earplugs, which offer flat attenuation vs. traditional earplugs, which tend to filter sound from higher frequencies, resulting in a muffled sound.
  • Protect your ears consistently every time you may be exposed to loud music and/or sounds, not just when you are performing.
  • Better yet, avoid noise as much as possible when you are not performing.
  • Invest in high-quality in-ear monitors and train your ears to use the lowest level that’s feasible.
  • Drummers should use dampening pads when possible.
  • Sound travels in a straight line so it’s louder directly in front of or behind a speaker. Spread out so you are not being blasted by the musician next to you. Move away from on-stage monitors and amplifiers.
  • If moving away is not an option, look into using baffles to protect yourself.
  • Take breaks of 15 minutes in between sets of music or rehearsals to give ears a rest. During rest periods go outside or somewhere quiet.
  • Whenever possible, practice at lower volume
    or play your electrified instrument unplugged.
  • Use smaller amps when possible.
  • Avoid ear buds and other direct-injection earphones for recreational listening, especially in loud environments.
  • Have your hearing tested frequently by an audiologist.
  • If it’s not possible to have regular professional sound-level assessments, at least use a sound meter app to check your exposure level.
  • Avoid signing up for repeated live gigs at loud clubs. If possible, give your ears some recovery time in between.

Michael Santucci, Au.D. works with the Audio Engineering Society (AES), where he is vice chair of the Technical Committee on Hearing and Hearing Loss Prevention. He operates a Musicians Hearing Clinic and works on hearing conservation through Sensaphonics: In-Ear Monitoring Systems.

Zika
Health, Resources

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.

Dry Eyes
Health, Resources

In the Spotlight: Help for Dry Eyes

Dry EyesDuring allergy season many people experience dry eyes. With age, it becomes more common and can be chronic. Whether you’re staring at a computer screen all day or reading music under stage lights, your eyes may begin to feel gritty and dry. The problem develops when the eye cannot maintain a healthy coating of tears.

There may be any number of causes: dry environment or workplace (wind or air conditioning); sun exposure, smoking or secondhand smoke exposure; cold or allergy medicines; or hormonal changes brought on by menopause.

People who work long hours staring at a computer screen are likely to blink less often and are more susceptible to dry eye. (Optimally, people should blink about 15 times a minute or every four seconds.) Those who have had Lasik or other refractive surgery, where their corneas have reduced sensation due to incisions or tissue removal, may also experience dry eye. Long-term contact lens wearers are also at risk.

More serious conditions—auto-immune diseases, such as lupus, rheumatoid arthritis, or thyroid disease—can contribute to the problem. Dry eyes can also be a symptom of Sjögren’s Syndrome, an autoimmune disorder associated with rheumatoid arthritis and other auto-immune diseases.

Any number of over-the-counter and prescription medications can reduce tear secretion.

While there is no cure for dry eye syndrome, you can find relief.

Here are some tips to help relieve dryness:

  • First, be sure to have regular eye exams. The American Optometric Association recommends that people aged 18-60 get eye exams every two years, as long as they are symptom-free. At-risk and symptomatic patients should have their eyes examined at least once a year and whenever they are experiencing problems.
  • Apply warm compresses on the eyes. Wet a clean cloth with warm water. Hold the cloth over your eyes for five minutes. Rewet the cloth with warm water when it cools. 
  • Control inflammation by cleaning lids with mild soap. (Ophthalmologists often recommend baby shampoo.) Apply cleanser on clean fingertips and gently massage your closed eyes near the base of your eyelashes. Rinse thoroughly.
  • Massage your eyelids to activate secretions.
  • Only use recommended eyelid cleaners.
  • Use artificial tear ointment or thick eye drops just before you go to bed.
  • Avoid using a hair dryer.
  • Run a humidifier to add moisture to the air.
  • Protect your eyes from sun and wind with sunglasses.
  • Consider adding more omega-3 oils to your diet (salmon, sardines, tuna, trout, anchovies, and flaxseeds). In studies omega oils appear to improve the eye’s Meibomian glands, which produce the oily part of tears. Fish oil may also reduce inflammation.
  • Try to avoid medications that deplete body fluids.
  • Ask your doctor about punctal plugs, which are placed in the tear ducts to retain lubrication.

If you have chronic dry eyes contact an ophthalmologist for evaluation. Left untreated, dry eye (keratoconjunctivitis) can lead to pain and more serious conditions such as ulcers, scars on the cornea, and partial impairment of vision. Permanent vision loss, however, is uncommon.

Health, Resources

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.

Cubital Tunnel Syndrome
Health, Resources

Don’t Fret: Cubital Tunnel Syndrome Is Treatable

Cubital Tunnel SyndromePeople often refer to any hand and wrist ailment as carpal tunnel syndrome, but ulnar tunnel syndrome (also called cubital tunnel syndrome) affects a specific part of the hand. Symptoms include numbness and tingling in the fifth digit (pinky finger) and half of the ring finger.

Musicians recognize the symptoms—numbness and tingling in the hand and fingers. Compression of the nerve commonly occurs behind the inside part of the elbow. Left untreated the strain can develop into weakness and acute pain in the fingers, which can extend to the elbow.

Unlike carpal tunnel, symptoms related to cubital tunnel syndrome can be better managed with conservative treatment, such as modifying activity level and using a brace. In rare cases, if the nerve compression is causing muscle weakness or severe pain in the hand, surgical intervention may be necessary.

The ulnar is the largest unprotected nerve in the body, which has very little soft tissue and muscle to protect it. Each time a musician bends his or her elbow, the ulnar nerve is slightly compressed. Sustaining a position for several hours a day can wreak havoc on this sensitive nerve. Most musicians need to bend their elbows to 90 degrees to simply hold their instruments. Add to that, normal activities like driving, computer use, and exercise and the pressure quickly multiplies. Oboists and bassoonists who make reeds add yet another occupational hazard by using and bending their elbows for even longer stretches.

Numbness commonly occurs at night and is related to the position of the arm. Sleeping with the elbow flexed will raise the pressure in the cubital tunnel three times more than normal. Sleeping with hands behind the head will raise the pressure seven times more than normal.

Guitarists typically have ulnar tunnel issues in their fretting arm and hand. The bent elbow and arched wrist actually stretches the nerve, and repetitive movement of the fretting hand fingers can cause irritation. Ulnar tunnel issues can sometimes be treated through stretching. You may also need to take a break from playing to allow the body to heal. 

Tips to Relieve Pain and Pressure

  • Straightening the arm at night will relieve numbness, and sleeping with the arm out straight may avoid hand numbness at night.
  • Practice good posture and ergonomics. Keep your shoulders back and head up while playing your instrument or using a computer.
  • Before playing, warm up properly with a stretching regimen.
  • Wear gloves during cold weather to protect your hands.
  • Avoid awkward positions, like resting your arm on the car window while driving.
  • Drink plenty of water to ensure that your joints and ligaments stay lubricated.
  • Wash your hands in warm water to loosen up before playing.
  • Take frequent rest breaks from any repetitive tasks.

If you ever feel pain or numbness while playing or performing any activity, stop! Always seek immediate medical advice for pain or injury.

Health, Resources

Trigger Points: A Pain in the Neck

by Dr. Marc Brodsky and Ron “Bumblefoot” Thal

Trigger Points, or knots, in the neck and shoulder muscles from repetitive use are common in musicians. In addition, chronic muscle-related pain of the head and neck may be exacerbated, or caused, by other conditions such as whiplash, migraine and tension headaches, temporomandibular joint (TMJ) disorders, fibromyalgia, and even cancer. This article explores how integrative medicine can be used to ease neck and upper back pain.

Case Study

A guitarist in his 40s continued to have neck and upper back pain following a car accident two years prior where he was rear-ended at a stop. An MRI revealed a herniated disc in his neck. He described the pain as a splinter that was permanently in his body, irritating him every day. His pain intensified while moving around stage playing his guitar, as well as during travel for touring. The pain persisted despite steroid injections and pills, physical therapy, and a trial of self-medication with alcohol. The guitar player finally found relief with a self-care program that included acupressure—pressing strategic points to release muscle knots in his neck and upper back. He also ate an anti-inflammatory diet and exercised with an arm bike and did push-ups. He specially designed a guitar case to take off some of the load from moving gear.

Highlights of Integrative Medicine Approach

If you are experiencing neck and upper back pain, a hands-on physical exam may find neck and upper back pressure points. They are most commonly found in two muscles: the trapezius (below, left) and splenius capitis (below, right):

A medical professional may use trigger point injections (TPI) to treat painful areas of muscles that contain muscle knots. In the TPI procedure, a small needle is inserted into the trigger point. The injection contains a local anesthetic or saline, which inactivates the trigger point to alleviate pain. Several sites may be injected in one visit. A brief course of treatment often results in sustained relief. Acupuncture and massage by licensed professionals may relieve muscle knot pain as well.

You may take an active role in relieving your own neck and upper back pain by pressing the acupressure points on your arms, neck, and upper back. Try these three techniques: 

1) Press on a point two inches down from the crease of the elbow.

2) Interlock the fingers and press the thumbs into the tender points below the base of the skull.

3) Place two tennis balls in a stocking and press them against a wall with your back using the weight of the body to access the pressure points below.

The recommended self-care routine for muscle knots in the neck and upper back is to press each of the acupressure points for the duration of three relaxing breaths (about 15 seconds) one to three times each day. This is a natural muscle relaxant and stress reliever.

For persistent neck and upper back pain always seek treatment from a medical professional.

Marc Brodsky, MD, is a 2017 member in good standing of the Performing Arts Medicine Association (PAMA). Ron ‘Bumblefoot’ Thal is a solo artist and producer. Images courtesy of Katrina Franzen, Junghwa Choe, and World Health Organization.

Andrew Schulman
Member Profiles

Andrew Schulman Creates Bridge to Healing for ICU Patients

Andrew Schulman

Andrew Schulman of Local 802 (New York City) is resident artist of the Louis Armstrong Center for Music and Medicine at the Beth Israel Medical Center.

Following pancreas surgery in 2009, Andrew Schulman of Local 802 (New York City) suffered cardiovascular collapse and was not expected to survive. When he came out of the coma, doctors called it a medical miracle. But Schulman, a professional musician and guitarist knew it was music that had reached him and brought him back.

At his bedside in the intensive care unit, Schulman’s wife, Wendy, thought music would comfort him in the ICU, but desperately hoped for more, that it just might be a lifeline. From his playlist she chose Bach’s St. Matthew Passion. Within an hour, Schulman’s vital signs began to stabilize. In three days, he emerged from the coma. No one would know exactly how he survived the first night, but Schulman, whose case has been cited in medical journals and at major medical conferences, says, “The day I came back, six months after being in ICU, people said, ‘You’re famous in this hospital.’”

In his book, Waking the Spirit: A Musician’s Journey Healing Body, Mind, and Soul, Schulman recounts his experience, from survival and recovery to his new calling as a medical musician. Drawing on the inspirational stories of the people he’s met, as well as experts in both music and neuroscience, Schulman reveals the powerful ways music helps patients negotiate illness. After his medical crisis, Schulman became a volunteer musician three days a week in the surgical ICU, and in 2011, was officially appointed resident artist of the Louis Armstrong Center for Music and Medicine at the Beth Israel Medical Center.

“The guitar is perfect for playing in this setting, especially if you need to make a modulation instantly,” Schulman says. Most patients in the ICU cannot make a request, but once in a while, someone will ask for Elvis or Gershwin. The right music, the right sound, makes a difference. A Bach prelude is typically calming. Music can make heart rhythms more regular, and lower stress hormone levels, heart rate, and blood pressure. Schulman says, “The key is finding the resonance frequency of a patient.”

Schulman has been working with trauma surgeon, Dr. Marvin A. McMillen, perioperative director at Berkshire Medical Center in Massachusetts, to develop a program of medical music specifically for post-op care. He expects to attract many professional musicians, but Schulman emphasizes it’s not a regular gig. It requires natural empathy, extreme motivation, and a sense of humor, plus the confidence to handle some rather complex medical information. He explains, “You’re the one who needs to keep up the spirits of patients. You have to play your Carnegie Hall best, all the while watching the patient’s face, hands, and feet because that’s where you can see agitation—checking the monitor and range of vital signs.” 

Of his renewed passion for life and music, Schulman says, “It’s like being in three worlds—a triad of music, medicine, and writing. I’m using much more of my brain than I ever did before.” He suffered brain damage during cardiac arrest—retrograde and anterograde  amnesia. In cases like this, although the nerve network for memory was damaged, the brain compensates by reorganizing the neural pathways to work around the deficiency. Called neuroplasticity, the neural rerouting allowed him to continue to play and read music, eventually relearning all the songs he had forgotten.

Schulman continues to play professionally with the Abaca String Band, his own quintet, and as a soloist. His steady union engagements include landmark New York City venues, the Palm Court at The Plaza Hotel, The Mark Hotel, and The InterContinental/Barclay. He’s performed at Carnegie Hall, the Improv, and the Royal Albert Hall in London. His CDs include The Baroque Style, Lullabies, Reveilles, (and Siesta!), and two Live from Chautauqua recordings.

Schulman was just out of college in 1975 when he joined Local 802. A year before his surgery, which coincided with the 2009 recession, his wife learned she had breast cancer. He says, “If it hadn’t been for emergency relief fund of Local 802, if they hadn’t helped us after my surgery, I don’t know what we would have done. I might have been evicted, might have lost my apartment. They helped us through a crucial three months. I’m forever grateful.”

Back to work, in a new role, Schulman reflects on the turning point in his own ICU experience, when he heard St. Matthew Passion. He says, “The greatest grace a musician can have is to play for a patient who’s in a critical care unit. Instead of hearing the cold harsh beeps and alarms of a medical machine and impersonal voices, they hear a beautiful flow of Bach or a melody or tune that’s soothing.”

Hand Pain
Health, Resources

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).