It can start during or after a performance, or in the middle of the night, seemingly out of the blue. Your finger curls down into your palm, and won’t straighten out again. Your neck remains twisted sideways even after you put down your violin. Your lip trembles when you try to play your horn. Sometimes there’s pain, sometimes not. These are all symptoms of focal dystonia, one of any number of injuries musicians can experience.
Carpal tunnel syndrome is another, as is tendinitis, even tennis elbow. Loud popping noises in the joints, a growing numbness in the hand, there isn’t one symptom or one diagnosis. Everyone who contracts this type of injury is different. There is debate over whether focal dystonia and carpal tunnel syndrome are even related. One thing is certain, however, repetitive motions are present in all of them. When it comes to musicians, the very idea they can’t play anymore causes extreme emotional distress, which only aggravates the injury.
There are more than 100 different kinds of syndromes colloquially called repetitive strain injuries (RSIs). Repeating the same motions or sitting in one position for too long, or both, causes them. Carpal tunnel syndrome has received the most press, but among musicians, focal dystonia is more prevalent, yet rarely discussed. For a musician to be dubbed injured can spell the end of their career. Dr. Joaquin Farias has long been treating afflicted musicians. His case studies show 10% of his patients experienced symptoms of either carpal tunnel or cubital tunnel syndrome (in the elbow) before the onset of focal dystonia.
Yet, whereas RSIs are treated as disorders involving muscles and bones, focal dystonia is seen as happening solely in the brain. Allopathic or traditional medicine treatments include physical therapy, muscle relaxers, painkillers, and surgery, to varying degrees of success. More and more, musicians are turning to movement retraining to get back to performance level.
A number of practitioners retrain musicians to play without injury. Some sufferers augment their allopathic treatments with these movement experts, while others solely rely on movement retraining. All retraining methods are based on the idea that somehow, somewhere, your body is relating to your instrument in a harmful way. With The Taubman Method, movements at the keyboard are seen to biomechanically overstress tissues in the wrist and hand. The technique involves keystroke timing that allows for maximum use of the keyboard, and minimum effort by the hands.
David Leisner developed his technique trying to cure his own painless focal dystonia. Leisner works with large muscles in the arm, rather than the smaller muscles in the knuckle joint and fingertip. He has returned to playing full time and now teaches his technique to others.
Farias’s approach is the most interesting. He sees the injuries as a problem of abnormal movement control, often caused by a sudden incident, such as carpal tunnel syndrome, or a profoundly impacting emotional experience associated with playing or the instrument. He uses neuroplasticity to reprogram his patients with a great deal of success. All of these treatment programs, however, require time out of a career that many can ill afford.
The best strategy is undoubtedly prevention. Poor posture is a key factor in RSIs. For Farias’ patients, sleep deprivation is often a consideration. Having your technique analyzed by someone qualified and getting enough sleep are good places to start. Leisner believes Shiatsu massage is helpful as a preventive measure too. Unfortunately, there are not many places musicians can go for help, and the demands of touring and performing often stymie treatment. For musicians without health insurance, it’s even worse.
RSI statistics specific to musicians come from Australia, where 84% of the players in the country’s eight full-time, professional orchestras experience pain that interferes with their performance. RSIs are something that can be prevented, treated, and recovered from with education and access to the proper treatment. Leisner says of his own injury, “I went to many different types of practitioners. Each said to me, ‘Yes, I can cure this problem,’ and no one did.” It’s a spaghetti-at-the-wall approach at best. That’s a shame when you consider how much music gives us all.
Jill Gambaro is the author of The Truth About Carpal Tunnel Syndrome, based upon her experiences living with repetitive strain injuries for 14 years. A former board member of the Los Angeles Repetitive Strain Injury Support Group and the Cumulative Trauma Disorders Resource Network, Gambaro advocates for RSI patients and workers’ compensation reforms. She is a professional writer and film producer. For information visit: www.truthaboutcarpaltunnel.com.