Tag Archives: healthy

Health of Orchestra Musicians

OCSM Looks at the Health of Orchestra Musicians

by Robert Fraser, President Organization of Canadian Symphony Musicians

When I began my studies many years ago, I had no idea of the physical hazards of musical performance. Overuse injuries, hearing loss, unsafe performance environments—these were all very new to me and there was relatively little research or remedy in this area. I had never even heard of the drug Inderal and was astonished when my first-year music history teacher mentioned in class how many musicians took it.

Fast-forward to 2018 and there is still much work to be done. While we continually work to improve our physical safety in the workplace, dangers to our personal well-being in the form of harassment still abound, and the demands of our profession can take a toll on our psychological health. In this column, I want to draw your attention to two significant surveys, both conducted in the UK but very relevant to our position in North America.

Early last month, a few news outlets reported on survey results released by the Incorporated Society of Musicians (www.ism.org), a UK-based organization. The survey is ongoing and can still be accessed through their website. I would invite readers to look at both the survey and the report on the initial period of responses from last November. The most telling statistic, and the one that was shared in all the press articles, is that almost 60% of the respondents reported some form of sexual harassment in their musical workplace, and of those 60%, a large majority of respondents who revealed their gender were female. (The survey gives respondents the option to not reveal gender or to choose  transgender; 71.71% identified as female and 10.53% chose not to identify gender.)

The report states that there were more than 250 voluntary respondents to the survey during this period. While this is not a large sample, it is telling nevertheless. It makes me wonder what the responses would be if such a survey was conducted through AFM player conference orchestras.

Another survey, done in 2016 by Help Musicians UK, was entitled Music Minds Matter (www.musicmindsmatter.org.uk) and it presents itself as being “the world’s largest known study of musicians’ mental health.” Of the 2,211 respondents, 71.1% believed they had experienced panic attacks and/or high levels of anxiety and 68.5% reported they had experienced depression—making musicians three times more likely to experience depression and anxiety than the public at-large.

Respondents to the survey listed a number of reasons for ill mental heath.

To quote directly from the summary report:

  • Poor working conditions including: difficulty sustaining a living, anti-social working hours, exhaustion, and the inability to plan their time/future
  • A lack of recognition for one’s work and the welding of music and identity into one’s own idea of selfhood
  • The physical impacts of a musical career, such as musculoskeletal disorders
  • Issues related to being a woman in the industry—from balancing work and family commitments, to sexist attitudes, and even sexual harassment

In October 2017, a follow-up to the Music Minds Matter survey (Phase 2) included in-depth interviews with 26 of the survey’s respondents. Again, quoting from the report, three suggested areas for change were:

  • Education
  • A code of best practice
  • A mental health support service for those working in music

At the last OCSM Conference in August, the delegates adopted a resolution to address all three of these areas. We resolved to “encourage orchestra managers to become familiar with The National Standard of Canada for Psychological Health and Safety in the Workplace. This document can be found at the website of the Mental Health Commission of Canada. It is a daunting document (more than 70 pages), but I encourage all our members to find and download it. Point it out to your locals, your orchestra committees, and your human resources personnel. This is one area where union-management collaboration and cooperation is a must. Having research and well-documented plans for implementation will help, but the road to good mental health and safety in the workplace will not be easy.

On behalf of the 1,200 members of OCSM, I wish you all a prosperous and healthy 2018, and to my colleagues in the symphony world, an exciting second half of your season.


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.

Cubital Tunnel Syndrome

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.

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.

Avoid the Flu

Avoid the Flu this Season: What You Need to Know

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

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

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

Who should not get a flu shot?

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

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

What are the flu vaccine delivery options?

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

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

Can the vaccine give me the flu?

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

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

What other illnesses mimic the flu?

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

What kind of protection does the flu vaccine offer?

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

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

What are other ways I can avoid the flu?

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

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

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

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

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

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

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

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

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

Where can I get vaccinated?

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