Tag Archives: pain

Pain
Health, International Musician

A Drug-Free Way to a Pain-Free Back

by Marc Brodsky, MD, and Craig Holiday Haynes

Chronic lower back pain may be the result of trauma or repetitive overuse injuries of the spine, intervertebral discs, ligaments, joint capsules, and muscles. Posture and psychological stress may also contribute. In a musician, lower back pain can be debilitating, interfering or worsening with activities related to playing an instrument.

While narcotic (opioid) pain medications can make life more comfortable, they come with inherent risks: accidental overdose, risk of dependence and addiction, side effects (sedation, dizziness, nausea, constipation, respiratory depression, etc.), and the need for increasingly stronger doses. In October 2017, the US President directed the Department of Health and Human Services to declare the opioid crisis a public health emergency. It is important to explore alternative treatments before turning to prescription drugs.

Case Study

One 52-year-old jazz drummer developed lower back pain after a motorcycle accident. He described shooting pains in his legs that interfered with his ability to play drums and to go on tour. An MRI revealed a herniated disc in his lower back. After disc surgery, the pain that traveled to his legs improved, but he continued to have pain across his lower back. The drummer got relief from his pain with trigger point injections, along with acupuncture, chiropractic, and massage treatments. He treated pain flare-ups with a self-care program that included acupressure and swimming exercises. 

Integrative Medicine Approach

Drug-free treatments to activate natural healing and restore resiliency may relieve pain and suffering and optimize quality of life. Self-care nonpharmaceutical treatments and techniques without side effects or risk of addiction are particularly important for performers. 

Myofascial trigger points are irritated spots in the fascia surrounding skeletal muscle. These small patches of clenched muscle fibres are sensitive and cause aching and stiffness. They often are a major factor in common problems like lower back pain and neck pain. Most minor trigger points are self-treatable.

 

Pain

A hands-on physical exam may locate trigger points in the muscles that, when pressed, cause pain in the lower back. For those experiencing lower back pain, pressure points are most commonly found in two muscles, the quadratus lumborum (left) and gluteus maximus (right).

Pain Relief Through Acupressure Points

Acupressure points take advantage of the body’s natural muscle relaxant and stress reliever. Since acupressure points and trigger points in the muscles overlap, you may get relief from your pain by utilizing exercises that press acupressure points in your back and legs. Try the exercises below for relief of lower back pain.

Exercise One

PainPain

Place two tennis balls in a stocking and press them against a wall with your back using the weight of the body. Press for the duration of about 15 seconds, one to three times per day.

 

Exercise Two

Pain

Press your finger into a point at the bottom part of the calf muscle.

Press each of the acupressure points for the duration of three relaxing breaths (about 15 seconds), one to three times each day. If lower back pain persists, see a medical professional.

 

 

 

10 Tips To Reduce Back Pain

1) Maintain a healthy weight.

2) Regularly take part in exercises
that strengthen your back and
core muscles.

3) Lift your equipment properly—always bending your knees and squatting to pick up heavy items.

4) Know your limits and don’t be shy about asking for help.

5) Use good posture throughout
the day.

6) Stretch your muscles.

7) Don’t carry a briefcase or heavy purse long distances as it changes your balance. Instead, use a
backpack.

8) Make sure your mattress is firm enough to support your back.
Soft mattresses can push it out
of alignment.

9) Get plenty of sleep.

10) Quit smoking.

As always, if back pain continues, see a specialist.

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.

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).

Stretches That Every Musician Should Do Before Playing
Health, Resources

Stretches That Every Musician Should Do Before Playing

by Janet Horvath, author of Playing (Less) Hurt: An Injury Prevention Guide for Musicians available at musicdispatch.com

Stretches That Every Musician Should Do Before PlayingEditor’s Note: In this article Janet Horvath suggests some stretches she devised to help musicians alleviate body stress. Always check with a physician before trying stretches, especially if you have an injury. Always stop any movement that causes pain.

When I was a young student I was criticized for moving too much when I played. “Don’t beat your foot! Don’t wiggle! It’s too distracting,” said my teachers. Unfortunately, these mantras were more important than just limiting comfort and self-expression. Although playing music is expressive and creative, we sought to quell the tendency to move and flow with the music. We were admonished to never “stick out.” As a result, we often sit like statues.

Studies today indicate that humans are born to move. Being static, still, and motionless is detrimental to our health. Static effort, or holding a position, is also much more strenuous on the body. Muscles tighten, blood flow is constricted, oxygen is not replenished, and waste products are not flushed out. Static positions make us tire sooner, and then we hurt. On the other hand, we can engage in a dynamic movement for a long time because blood is replenished with fresh oxygen.

There are unobtrusive ways to reduce tension build up and give our bodies mini breaks. I have devised a series of moves I call Onstage Tricks™ to alleviate tension even while performing. The essential guiding factor is to do the opposite motion of the positions we are required to hold while we play.

Sitting properly is the first step. Make sure that you are sitting in the optimum position for your height and instrument. Your chair should be high enough so that your knees are lower than your hips. If you are diminutive, sit forward so your feet don’t dangle. Your weight should be forward with a slight lumbar curve in your spine and feet flat on the ground. Keep your shoulders down and facing forward. Avoid turning or twisting your torso, leaning left or right.

Starting with those targeting the top of the body, try some of the following moves during practice or performance, or whenever you have a few bars of rest. These exercises are effective even if you only have time to do them once. However, if you are able to do them more than once, it’s all the better.

The following are stretches that every musician should do before playing

For the neck:

  • Keep your head erect and tuck in your chin gently. This is a very small movement.
  • Tuck your chin as above. Keeping your shoulders relaxed and down, slowly turn your head to the right and look over your right shoulder; return to looking forward. Repeat, turning your head left, looking over your left shoulder.
  • Again, start with a chin tuck. With shoulders relaxed and down, slowly tilt your head so the right ear is over the right shoulder. Return to neutral. Repeat on the left side.

For shoulders and pectorals:

  • Do one big shoulder shrug bringing the shoulders toward the ears, while taking a deep breath. Relax, release your shoulders, and breathe out.
  • Do one big shoulder circle. Bring your shoulders forward, then up toward your ears, then back opening your chest, and relax bringing your shoulders to normal. Repeat, reversing the direction of the circle.
  • While keeping your shoulders down, squeeze your shoulder blades together.
  • Clasp your hands behind your back, and while keeping your elbows straight, but not locked, pull your shoulders gently backwards.

For the arms:

  • Let your arms uncurl often and hang by your sides. (If you must hold your instrument, do one arm at a time.) While keeping your elbows fairly straight, but not locked, turn your palms outward, with your thumbs pointing away from your body. Moving slowly, reach gently backward.
  • Place your hand palm down on the chair behind you. While keeping your elbow fairly straight, but not locked, lean gently onto your hand, stretching the inner arm. Repeat with the other arm.

For the back, spine, and pelvis:

  • Take a deep breath in and then empty your lungs. Now, contract your abdomen. Imagine pulling your belly button inward. Release.
  • Roll your pelvis forward and back, putting your back into a “C” curve. Momentarily press your lumbar spine backward and then return to neutral. This is a very small movement. Rock from one gluteus to the other, side to side.
  • Squeeze your buttocks and release. This can be done while standing or seated.

For the hips:

  • Keep your feet on the floor and turn one knee inward as you sit, rotating the hip joint. Repeat with the other leg.
  • Adjust the position of your feet often.

For healthy overall circulation:

  • Keep your heels on the floor and lift your toes. Then, keep your toes on the floor and lift your heels. Do circles with your ankles.
  • If you are able to, alternate playing seated and standing. While standing, avoid locking your knees; keep them slightly bent with feet apart. Avoid overarching your back and crouching or slumping forward. Keep your head and torso erect and face forward with shoulders down.

Awareness is the key to injury prevention. These and many more “moves” for musicians are displayed in my book. Make up some of your own as well, with the goal of maintaining fluidity and ease, while avoiding tightness and tension. You’ll feel better and you’ll play better too.