When a musician needs a physician

When a musician needs a physician

When the Musician Needs a Physician

Three out of four musicians surveyed said they had experienced at least one playing-related medical problem severe enough to affect their performance, according to a report from the University of Texas Medical School and Hermann Hospital in Houston.

Dr. Alan Lockwood surveyed 2,112 members of the International Conference of Symphony and Opera Musicians (ICSOM) and found that their playing-related problems fell into four basic categories: (1) overuse syndrome, (2) neural impingement, (3) focal dystonias, and (4) psychological stress.

The most frequently cited problem, overuse syndrome, was reported by 64% of the musicians, and was defined as “injuries caused by the cumulative effects on tissues of repetitive physical stress that exceeds physiologic limits.” Overuse syndrome most frequently involves the muscles and tendons of the hands, Dr. Lockwood said, and the symptoms can range from “mild pain while the musician is playing to pain severe enough to preclude use of the hand.” The greatest risk factor for overuse syndrome is “the use of repetitive movements during long hours of practice,” he said, “but awkward body positions mandated by the shape and weight of the instrument, the technical difficulty of the repertoire, and unfamiliar instruments may also play a part.”

In the survey, string players were most likely to experience this condition, and women were more commonly affected than men. The cornerstone of therapy for overuse syndrome, he said, is rest. Neural impingement involves the swelling of the tissues surrounding nerves, and most commonly takes the form of carpal tunnel syndrome (compression of the nerves leading to the hand), although it can also involve the entire arm. It can be caused by traumatic injuries, or, like overuse syndrome, by the repetitive motions associated with playing.

The symptoms include pain, loss of strength, and sensory abnormalities in the affected area. Physical therapy is often effective in relieving the problem, Dr. Lockwood said, and “may be supplemented by instrumental adjustments that remove weight from the shoulder.”

Focal dystonia — a loss of muscle tone that can affect isolated muscles in the body, or that can be generalized — causes musicians to experience incoordination while playing, “frequently accompanied by involuntary curling or extension of fingers.”

Facial muscles may also be involved, causing problems with the embouchure (the positioning of the lips) in musicians who play wind instruments. The cause of dystonia has not been determined, and a variety of treatments — including psychotherapy, biofeedback, muscle retraining, surgery, and a host of pharmaceuticals — have yielded disappointing results thus far. Psychological stress associated with performing was a commonly reported problem among the musicians.

Beta-adrenergic blocking agents (beta-blockers), which slow the heart rate and lower blood pressure, are commonly used by performers to relieve anxiety, the author said, often without the supervision of a physician.

COPYRIGHT 1989 Vegetus Publications

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