Agility and Artistry

When I started writing these articles, there was a topic I very much felt needed attention but was unable to implement.

A useful presentation eluded me and as I lacked clarity of not only content but a focused way to provide anything useful. That topic was: What do we do when our bodies fail us? How do we cope when we can no longer play our instrument or command it in a professional capacity?

I hope to revisit the broader dialogue of this later, but felt that a positive and practical presentation was an appropriate way to open.

Most people would not immediately respond to the musician’s career as one on par with other more obvious jobs that require manual labor to perform. Learning an instrument is actually one of the least creative tasks one can undertake. The successful instrumentalist follows instructions for a very specific skill acquired by hard work applying rule to function by instruction. Creating is a luxury secondary to skill. Similarly, we, as musicians, must approach the profession first as a function of income in our lives.

One in which there are realities we must attend to for continued successful sustainable work. We need to build healthy physical parameters as our bodies age if professional expectations are to be retained for a lifetime.

Whether the cause be an injury (playing injury or otherwise), ailment of a chronic or disabling nature, results of an accident, or degenerative effects of aging and the “wear-and-tear” of daily use, the inability to play is devastating. Most performance-based skills are going to rely heavily upon one’s physical health (and emotional well-being). That is terrifying to be aware of as there are so many ways in which health can be compromised.

Consequently, it is not something we intentionally discuss or like to think about. I can’t recall such a discussion arising amongst fellow musicians. It is too painful and scary. That our bodies age and loose agility is often considered an unavoidable reality that is best not to dwell upon. There is no bargain or substitute for our health.

One major defining quality of professional music-making is that very little exists to protect or allow for our employment in the instance of illness. A few months ago, I had to take a few weeks off work for emergency dental surgery. It was devastating; my schedule wouldn’t manage makeup lessons for most of my students. Add the additional bills from the surgery to two weeks of lost income and inability to physically manage the other work aside from teaching during recovery, and devastating is not an ill-fitting description. And that was just two weeks! It is no small thing, then, when faced with the dilemma of whether one ought to take time off playing the instrument that is your main source of income to allow tendons and nerves and muscles to properly heal. Sadly, in most situations, there is no guarantee there will be suitable employment to come back to. With this reality in mind, I hope to provide some medically-backed assistance for musicians to use as a guideline for making the best of these situations and avoiding them if at all possible.

In a string-player’s world there are three aspects of “on-the-job” demands placed on our bodies that are acknowledged to cause especially strenuous conditions for a healthy body. If an individual has additional existing conditions or chronic symptoms that require management, it can be a huge drain of resources just to maintain a state of wellness. These aspects are repetitive motion, long hours of restricted motion in a fixed posture (practicing, rehearsing, performing, teaching etc.), and travel (which varies by individual).

I would like to point out that while it is true that incorrect use of technique can contribute to or cause injury, it doesn’t mean that injury is indicative of bad technique.

Dr. John L. Burley; Joelton Chiropractic Clinic

Consulting Physician: Musculoskeletal Health

Many thanks for providing us with the following interview responses!

Most of us know that pain is indicative of something going wrong in our bodies that requires attention and treatment. What is not often clear is how much is safe to ignore or what kind of pain is acceptable to self-manage and what are the warning signs that we need to stop and seek the advice of a physician or healer before permanent damage is incurred.

Q: What is an indication that our bodies are in a state of emergency? When do we know that we are close or have reached a point in which we need to stop and seek treatment for to a playing injury or overuse damage)?

A: Reference through a thorough process of taking a patient’s history is always a good indicator of the degree of complexity a health issue has and how long it has been going on. Usually in these cases the severity of the signs and symptoms occur with more frequency and severity over time [creating the history’s narrative].

We need to educate patients in the skill of listening to their own bodies as things progress with knowledge regarding the signs and symptoms they experience. With this education the patient will be aware of the specialist needed to evaluate and determine if and when treatments are indicated. This would be where an emergency situation is diagnosed.

Q: Is there a point of no return or is there always a viable option to return to the state of function necessary to continue professional work?

A: The “point of no return” depends on how many options or lack thereof the patient has in the treatment of their condition or disease. In many cases there are viable options in determining whether that pertains to emergency care.

Q: How much value is there to be found in accurately using warm water (before playing) and ice (after playing) as a preventative tool? Are they equally effective when used to treat chronic (career) vs. acute (injury from either overuse/abuse) pain?

A: There is real value in these preventative procedures (cryotherapy). This seems to be more effective in the acute phase of these conditions than if there is an existing chronic illness. I will always recommend developing a regular routine consisting of good preventative habits associated particularly with repetitive type of injuries such as in playing an instrument.

Q: I am fairly certain that most serious string players at some point find the need to apply ace bandages, splints, wraps, and other similar supportive product indicated for the treatment of (usually) “tennis elbow,” tendonitis, carpel tunnel (etc). Are the use of such products useful for healing and how do we use them to best facilitate healthy use of our bodies while in a state of inflammation? (ex. A question very often asked is: do we wear supports while we play or at rest? Should we be restricting movement or aiming to keep affected joints loose? Are there some approaches that work better than others (such as weighted pressure pads that re-assign or redistribute weight to assist and/or widen the range of muscle function supporting the “weak side,” or doubling up support to aid the opposing side that has taken on increased burdens for functioning as the affected muscles recover mobility)?

A: This is an interesting view that is mentioned. I’ve personally been an advocate of wrapping to help with stability and to help with alleviating the stress and pressure that are put on areas of particular activity and constant use. There is a line of thinking in my industry that fixation is the root of many problems people have and that moving the joint properly is important to relieve the fixation so the joint can properly heal. Wrapping is useful to prevent hypermobility and aid the healing process.

Recognizing the Body’s Language

As Burley has indicated, most of the issues we find need to manage are cumulative, and as such, our body has a system intended to alert and warn that damaging behaviors or actions are occurring. Since often we are in a situation where we are performing repetitive motions while compromising movements to keep loose, we must pay special attention to what our bodies are warning us against when we are done with these situations so we are always actively adjusting how we do or do not use ourselves in roles of music-making. Posture and balance and support. Get to know your muscles, as they are often the first to register overuse and abuse before the other systems become compromised.

Burley advises:

Muscular: “tends to present with tightness and/or spasms; often muscles will become weakened when the nerves supplies or nutritional supplies become cut off from the muscle group.”

Nerve: “is usually indicated with restriction or pressure on the nerve whether at the nerve root or where there is an entrapment to freedom of nerve energy along the nerve corridor to various areas of the body such as the arms or legs.”

Tendon/Joint: “injuries are often the cause of loss of mobility or restriction of motion within areas registering pain and heat. Heat indicates the body is dealing with inflammation and typically involves some degree of swelling (adipose tissue).”

Often the requirements of the profession include significant travel (driving) on the same day that we have up to six hours of focused rehearsals. Typically one drives a distance to a hotel or lodging, attends a 2.5-3 hour rehearsal, takes a few hours break and then has a second rehearsal in the evening (or has to drive back after rehearsing). This is significant. Having a vehicle that “rides smooth” or vibrates a lot can determine how much we can handle.

Can contribute significantly to pain levels. Something we can control (usually) is how we position our bodies and set our seats and steering wheel height to minimize strain on the back, neck, arms, legs…(alignment of head to toe).

Burley offered the following tips and advice on how to go about setting up the driving environment for optimal relaxation while driving or correct posture while driving: “There is relevance in what was already mentioned by having a vehicle that doesn’t contribute to already withstanding areas of complaint or injury. This can be by having good tires, shocks and seats to withstand any additional impact on these [weak] areas. Positioning your body so that there is minimal strain to neck and shoulders in the head back cushion positioned in a neutral or level position so that your head is hitting back against it flush and making sure you have enough lumbar support by utilizing a cushion and/or pillow to put behind the lower back to support these areas. Even sitting on a cushion if necessary for additional comfort. Position the steering column at arm’s length so that it isn’t too far or too close to the body with the shoulders staying relaxed as well.”

For several years there was one very specific muscle group in my lower back that would become strained after driving for several hours. I placed a tennis ball behind and just below that muscle and concentrated on relaxing into the ball while driving. That was very helpful until I was able to upgrade my driving experience.

Burley concludes: “The basic rules of giving a body the ability to maintain a profession that puts a body at risk is to minimize additional stress outside of those times where those conditions exist due to other tasks one needs to do. Once one has been treated for any dysfunction that exists, that mild exercise such as walking and stretching are needed to maintain health on a preventative basis moving forward with these professions that stress specific areas more than other jobs do. Another factor is adequately managing psychological stress which can tighten muscles and interfere with the body’s natural healing processes as well as create an environment in which inflammation thrives.”