Musician Health: Therapeutic Treatment for Tendinopathyby Isabelle Duchesne
/ July 1, 2011
The following article is the fourth of a series on the prevention of music-related injuries. It is based on an article published by the author in January 2010 in the journal Le médecin du Québec in a special edition about art medicine. The previous article concerned the most common musculoskeletal disorders.
Musicians are patients in a class of their own, in that subtle changes to their motor skills most deeply affect them. Their diagnostic test includes a unique component: an evaluation on their instrument, which helps the practitioner specialized in art medicine to make a proper diagnostic and to find the problem at the source of the injury. “The posture should support the repetitive and highly technical movements required by instrumental performance. It shouldn’t hinder, but free up the smooth functioning of the hand and the fingers during musical interpretation,” explains Philippe Chamagne in his article “Éducation physique préventive pour les musiciens” (aleXitère, 1998)
In physiotherapy, evaluation should be oriented towards a biomechanical analysis of movement (study of the mechanics of body movement) and posture while playing in order to evaluate the mechanical stress induced on the instrument.
Treatment will be directed mainly towards the correction of postural, articular and dynamic muscular imbalances (in movement) found in the musician while he or she is playing. Since play directly and indirectly solicits proximal stabilizer muscles, it is of utmost importance to globally evaluate the musician, including the trunk and scapular belt.
Attenuating Symptoms with an Exercise Program
Pain in muscles of the forearm or the hand can be caused by excessive stress imposed upon them. Often, this excess is due to a weakness or reduced endurance in proximal muscles (muscles of the scapular belt) that support the superior limb (photos 2 and 3). A specific muscular reinforcement program will be required in order to stabilize this structure.
When it comes to the forearm, “the flexibility and strength of the wrist require a balance between the flexor and extensor muscles, but also between the muscles that bend the wrist on the radial (thumb) and cubital (auricular) sides. The posterior cubital muscles become important in supporting the cubital side of the moving hand and in counterbalancing the strength of the radial and abductor muscles of the thumb”, Chamagne explains.
Orthotics and Instrument Rest: Therapeutic Modalities
Wearing orthotics changes muscular mechanics and facilitates cellular regeneration by reducing the burden on the affected tendon.
When it comes to prescribing a period of rest from the instrument, the period must be closely studied with the musician. According to Brandfonbrener’s experiment, partial rest is usually preferable to complete rest. In the latter case, not only do musical abilities deteriorate quickly, but the level of anxiety and depression increase in proportion to this deterioration. By partial rest, we mean a period of minimal musical activity associated with a gradual augmentation of practice time on the instrument. In parallel, a progressive increase of piece difficulty is recommended.
Finally, scientific literature also prescribes acupuncture as a way of soothing short-term pain.
In the next article, we will discuss the most common peripheral nerve attacks (neuropathy) for musicians.
Isabelle Duchesne, B Sc., Pht, FCAMT and Fellow of the Canadian Academy of Manual Therapy, is a physiotherapist for Kinatex Sports Physio Rosemont and Downtown. She has been treating professional musicians for years.
Translation: Catherine Hine