Articles or commentaries including research abstracts addressing performing arts medicine will be included in this section. If you would like to submit an article please send it to me, Nick Quarrier
Cumulative trauma, repetitive stress, overuse injuries, are all terms used to describe the cause of many music-related injuries. But why do some individuals, who perform repetitious activities, become injured while others do not? The answer to this million dollar question may be that repetitious activity is not injurious by itself unless it is performed in an abnormal stressful posture. More importantly, the abnormal stressed posture may be the cause of a large percentage of music-related injuries.
The most energy efficient movement of the skeletal joints is performed with the joints in neutral positions. This means not overly flexed nor extended. In this position the muscles have the best mechanical advantage to move the skeletal parts. In neutral position there are no abnormal stresses imparted in the joint ligaments and capsule. The body part can be moved, in a repetitious fashion, quite efficiently in and around this neutral position, or so called postural boundary zone. The body part can be moved periodically, out of bounds, to full end range without abnormal musculo-ligamentous stress, and the muscles may still be energy efficient, but mechanical advantage is reduced at end range. This is exemplified by the individual unable to lift maximum weight at end ranges of motion as compared to at mid range.
If movement is performed for a prolonged time at end range, muscle fatigue may occur and ligaments may be stressed. This out of bounds repetitious movement seems to be most prevalent when evaluating an injured musician. One of the most detrimental and common out of bound postures are extreme ulnar or radial deviation of the wrist. (This stressful position is further compounded if flexion or extension is added to the wrist) Keyboard instrumentalists seem particularly plagued by abnormal ulnar deviation. Certainly, extreme ulnar deviation is required in some musical passages but the movement out of bounds should only occur for very brief moments and not be maintained for prolonged periods. Often just repositioning the piano stool helps to eliminate this stressful posturing.
The key and finger positions used by many woodwinds tends to place the wrist in extreme ulnar or radial deviation also. This is more difficult to relieve than by merely moving the seat. Often the musician's fingers cannot reach the keys in any other position. Some key adaptations may be fabricated, but often the musician doesn't have the money for this or fears that making instrument adjustments may effect the tone or playing ability. In this case, she must learn to move the wrist back into boundaries whenever a rest in the music occurs, and or learn to move the wrist back and forth during playing. Exaggerated wrist movement may be taught in the beginning (only to be performed in the practice room) with eventually refining the movement to be more aesthetically pleasing later. This then may be possible to use in a performance situation.
It is mandatory when evaluating an individual with a music-related injury to closely observe the musician's posture while actually playing the instrument. It is common to find no positive tests or findings during physical assessment until the dynamic evaluation of playing posture is performed.
It is thought that there is a correlation between upper extremity injuries and adverse mechanical tension. A recent study was carried out in Salzburg, Austria to investigate if a correlation exists. Thirty musicians were screened, looking at a subjective and objective evaluation. This information was entered directly into a data base software. Upon return to the states, the information was queried to look at the relationship between the subjective complaints of upper extremity injury in elite musicians and a positive neuro-tension sign.
The musicians were broken into five group as follows:
A: positive UE injury, positive BPTT, BPTT reproduced signs of UE injury B: positive UE injury, positive BPTT, with no reproduciton of signs C: positive UE injury, negative BPTT D: negative UE injury, positive BPTT E: negative UE injury, negative BPTT
Results were as follows:
A: 7/24 or 29% B: 2/24 or 08% C: 4/24 or 17% D: 6/24 or 25% E: 5/24 or 21%
The results only show that we have a greater need to investigate the correlations. Another valid point would be to investigate if treatment of upper extremity injuries with neuro mobilization relieves symptoms. This would open a large window of possibilities in prevention and cross training of elite musicians.
If you have further interest in this study, or would be interested in setting up a study with a local school of music or symphony, please free to contact me through the e-mail. Brent Andersen
The Canadian Network for Health in the Arts (CNHA) was founded in 1995 to meet the needs of the growing number of individuals who are involved with health issues for performing artists. The aim of the CNHA is to bring together individuals who are active in various aspects of Performing Arts Medicine with each other and with performing artists who are interested in learning about the current activities and research in the field. This link between performing artists and health professionals aims to have representation from orchestras, dance companies, universities, and other arts organizations. A home page web is, CNHA on the world wide web is coming soon. International membership is welcome.
For more information please contact Christine Zaza, PhD U of Western Ontario, (519)668-1835)
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