06 February 2014

Repetitive Overuse Injuries In Musicians (PART II)-TREATMENT

The road to becoming an accomplished musician requires thousands of hours of practice, repetition and conditioning of muscles specific to the instrument played. It is common for musicians to exhibit an inability to relax while playing, especially when learning a new phrase or trill. The repetitive nature of playing an intricate part in a tensed manner, whether gripping the instrument too tight, striking a series of keys too hard or attempting to play a part faster can lead to repetitive overuse injuries.

In Part I of Repetitive Overuse Injuries In Musicians, we described the type of repetitive overuse injuries that occur in musicians. In this segment we will discuss the various treatment options to help alleviate pain and restore proper function. The idea is to detect the problematic area and focus treatment to that area in effort to rehabilitate damaged or overused tissue and regain efficient movement patterns.

From Part I, let’s review Repetitive Overuse Injuries

Repetitive overuse injuries, or repetitive strain injuries, are injuries that occur when a body part is repeatedly stressed or irritated while executing a task. Repetitive overuse injuries can cause tissue edema (swelling), tendonitis (inflammation of a tendon), acute and chronic joint pain and dysfunction, myofascitis (inflammation of muscle and fascia) and muscle and ligament strains and sprains. Examples of repetitive overuse injuries are: carpal tunnel syndrome, tennis elbow, golfer’s elbow, radial tunnel syndrome, cubital tunnel syndrome, iliotibial band syndrome, thoracic outlet syndrome, De Quervain Syndrome and trigger finger.

Treatment of Repetitive Overuse Injuries

FOREARM

Pronator Teres and Supinator

When dealing with the forearm in musicians with pain and discomfort we must look at two very important muscles. The pronator teres and supinator muscles. These two muscles work hand in hand and must be assessed. Palpation of these muscles will very often illicit pain and hypertonicity, spasms and dysfunction (Active/Passive restriction and pain during pronation or supination). Applying Active Release Techniques® protocols to these two muscles by a credentialed provider will aid in relieving tension and pain and ultimately restore normal function.

Radial Head

Restriction and pain in rotation of the radial head upon active or passive pronation/supination of the forearm can be corrected utilizing passive pronation/supination of the forearm and Active Release Techniques® protocol to the radial head of the radius. Trigger points or myofascial adhesions in the brachioradialis muscle can also be corrected using Active Release Techniques® protocol for this particular muscle.

Flexors and Extensors

Forearm flexors and extensors should also be assessed and evaluated. Active Release Techniques® protocols and proper stretching to these muscles will also aid in alleviation of pain, discomfort and dysfunction with the goal of restoring adequate function.

HAND AND WRIST

When dealing with the hand and wrist it is important to understand the movement patterns that are causing pain and dysfunction. I find it helpful to have the musician play the instrument upon evaluation. Watch the movement patterns. Where is the overuse occurring? Can you see patterns that are causing stress, pain or dysfunction to the body or body part? Is the musician’s body in a position that is stressing the hand or wrist? Is there a better anatomical position?

When treating these areas I find it important to palpate these regions more thoroughly. As in the forearm, there is a lot going on in the hand and wrist and sometimes, by taking your time by assessing and evaluating the carpal bones and metacarpal bones (PIPS/DIPS as well), dysfunction is detected and is corrected by chiropractic adjustments to these regions or Active Release Protocols® specific to the muscles being addressed in the hand and wrist.

NECK AND UPPER BACK

Extremely important muscles that you must look at immediately when addressing the neck and upper back are the posterior cervical muscles, upper trapezius, levator scapulae and rhomboids. Before there is even consideration of chiropractic adjustments to the neck and upper back, once again we must look at the soft tissue first. Typically, most musicians have decreased function on the side that they favor. So, it is important to look at the particular side first. Is there pain and tenderness in the posterior cervical muscles on the dominant side? Are there muscle spasms in the upper trapezius, levator scapulae and rhomboids on the overused or dominant side? Usually the findings are consistent with this idea. Again, Active Release Techniques® to these muscles will aid in reducing pain and restoring function. Specific chiropractic adjustments to the cervical spine and upper thoracic spine will restore proper range of motion/function.

HIPS AND LOW BACK

Drummers and percussionists sit a lot. They are tight, trust me, I’ve talked to many of them. They’re all tight in the low back and hips. Why? Well, prolonged sitting causes shortening of the hip flexors, hamstrings, erector spine, compression of the glutes and lumbar joint dysfunction. Percussionists tend to sit and play in one (or two) positions for extending periods of time. Time seated=time shortened=time in pain. It’s a vicious cycle. So, it’s fairly straight forward. Check motion in the lumbar spine. Most likely, it will be moderately to severely restricted. The glutes, hip flexors, hips and low back will be locked up muscularly and joint-wise. Implement Active Release Techniques® to the problematic areas and of course….ADJUST THE SPINE and extremities (hips)! Adjustments restore normal range of motion, balance, homeostasis and allow the body to reconvene and do what it’s supposed to do; CORRECT ITSELF.

If you are a musician that is dealing with a stubborn overuse injury that has become chronically debilitating please contact a chiropractor that specializes in diagnoses and treatment of soft tissue injuries or call Dr. Frank for a consultation.