Watch Out For RTIs

Nov 12, 2014

Last week we took a quick look at one of the possible hazards of playing an instrument professionally: hearing loss. As I tried to stress last week, and want to stress again now, this is not usually a problem for amateur players. Most people are simply not reaching the required decibels on a frequent enough basis for there to be much risk of hearing impairment. That being said, there are some things that even the casual musician must be on the look out for; harm with the potential to end your ability to play your instrument permanently. The damage I speak of is Repetitive Strain Injuries (RTIs), and while they can be devastating to a musical career, most can be treated or prevented with proper care. Before you can prevent or treat an injury, first you must understand what that injury is, and how it happens.

While doing research for this post I came across an article comparing musicians to athletes. Admittedly, I initially thought the comparison was a little silly, but after reading more on the subject, I understand the point that author was trying to make. Competitive athletes spend countless hours training, not only their bodies, but their minds as well. They need to be able to perform physically while maintaining a sharp, focused mind at a moment’s notice. And just like their athletic counterparts, musicians can suffer physical pain for their love. Resulting from improper technique, over excursion, or good old fashioned bad luck, RTIs can start as a dull ache or pain, but if left untreated, can grow to be crippling. According to David S. Weiss MD, Clinical Associate Professor of Orthopaedic Surgery at New York University School of Medicine and the orthopaedic consultant to the Julliard School in New York City, says “Most of what we see in musicians are overuse injuries in the extremities… Problems can occur in anything that powers the arms – neck, shoulders, upper back, shoulder blades, and down to the fingers. Overuse of anything in that area can cause a problem.” One of the most common RTIs is tendinitis, a word that strikes terror in the hearts of musicians everywhere. But Dr. Weiss stresses that it does not necessarily mean the end of your playing days. What many people don’t understand is that the “itis” in “tendinitis” is a medical term that refers to inflammation. Hence, “tendinitis” refers to an inflammation of the tendons. In most cases mild tendinitis is simply a result of over using the muscles and tendons in your arm a bit. While it is true that in some worst case scenarios the tendons can become so damaged that it can end a musical career, the vast majority of cases are easily treatable. Another RTI that is common among musicians is Carpal Tunnel Syndrome. This is a condition that is usually found in older patients, and there is a good reason for that. There is something like a tunnel in your wrist for all the tendons that control your hand and fingers, as well as the median nerve, to pass through. Our tendons have a tendency to get thicker as we age, as part of a natural process. The tunnel has limited space, so as the tendons of the hand get thicker, the tunnel becomes crowded. Some people get it, some people don’t, but taking a few simple precautions against Carpal Tunnel and other RTIs is fairly simple.

The first major bit of advice when it comes to avoiding RTIs is the same advice given to athletes (there’s that comparison again): listen to your body. Even before you feel pain, your body will give you signs that it’s time to take a break. Like when you spend a day walking through a city or mall. Your calves get heavy, tired, overused, but not necessarily feel pain yet. The same thing will happen with your arms when playing. Take note, and take a break, before the pain begins. According to Dr. Weiss, “Many injuries we see happen because a lot of musicians just don’t stop when they really know that they should.” Which is a nice segue into the next point: take an actual break.

When you start to feel that weakness, or heaviness in your arm or wrist that says it’s break time, actually take a real break. Step away from the instrument, stretch, do something different. That being said, try to avoid that “something different” being on the computer. Leaving one chair for another, substituting one repetitive motion for another, will not help. Get up from the chair, move away from the keyboard, and actually enjoy your break. On the other hand, if your practising schedule or routine is sporadic or rigorous, try smoothing it out a bit. Practice at more consistent times, and spread out the parts you practice. If you have a tendency to play for a few hours at a particular time of day, try breaking it up a bit. Play for an hour in the morning, and two in the afternoon for example. Even small changes can lower the stress on your arms, wrists, and hands. Dr. Weiss says, “If you have a particularly difficult passage that you need to get down, but every time you try to play it something hurts, put it aside… Work on some other section. You always need to step back at the first signs of overuse and not push things until the point of ‘this really hurts and I can’t play any more.’”

RTIs have a tendency to be a bit more prevalent in self-taught musicians. The reasons for this can be a little obvious: without the benefit of professional training, technique can be somewhat compromised. A simple example of this that comes to mind is the amateur, self-taught guitar player who learned his or her technique by watching their favourite bands on TV. This kind of training might lead a budding musician to wear or hold their guitar incorrectly, leading to incorrect movement, resulting in painful RTIs. If you are a self-taught musician and are suffering pain, consider investing in a lesson with an experienced music teacher. They will almost certainly be able to help you correct an imperfections with your technique.

In the end, sometimes you just can’t avoid seeing your doctor. If you start to experience actual pain that impedes your playing, it is time to seek medical attention. Dr. Weiss has some helpful advice here to, suggesting you attentive, even after you’ve gotten to the examination room. “Be aware that a lot of physicians don’t know a lot about musicians and may want to tell you to keep playing, but just take anti-inflammatory medicine.” And this treatment would almost certainly help in the short term, dealing with the muscle or tendon pain. However, if the root cause of your pain is incorrect posture or technique, the problem will not go away with a few pills. The pain will most likely be back, and the problem will only be getting worse.

Remember, RTIs are almost always treatable, so if you start to feel pain when you play don’t panic. Re-evaluate your practising regiment and your playing technique. Listen to your body the way an athlete does. See a doctor if necessary. Stay safe out there everybody!