In Tune
OT for Musicians Strikes a Chord
By Heather World
Monday April 13, 2009
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Treating the Musician
Musicians tend to suffer strain from an imbalanced use of muscle power. Violinists can overuse their right elbow flexor muscles due to forceful bowing. Stretching those flexors and exercising both flexors and extensors prevents imbalance.
For focal dystonia in a pianist’s fingers, Kelly Belinsky, MS, OTR/L, uses splints to keep the digits straight. Pianists also may be able to revise their finger patterns.
Rebecca Barton, DHS, OTR, advises her clients to check with teachers for other finger patterns or holding positions that might alleviate common strains.
Therapists can direct musicians toward adaptations to their instruments, from higher chin rests to special equipment that bears the weight of an oboe or clarinet. Other hazards that can be avoided include playing in the cold, in loud environments, and in poor light, as well as avoiding awkwardly placed music stands.
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Kelly Belinsky, MS, OTR/L, owner of Performing Arts Occupational Therapy, in Brookline, Mass., knows the seamy underbelly of rock star life: tendonitis, focal dystonia, compressed nerves, and repetitive stress syndrome. Not sex, not drugs, but still rock ‘n’ roll, such injuries are the mundane yet disabling side effects of serious music, pop to classical. Intense practice sessions, tiring tours, and the odd positioning required for many instruments can, if untreated, force musicians to give up their life’s passion completely.“Musicians are a unique population,” says Belinsky, one of a growing class of occupational therapists specializing in their rehabilitation. “I feel like I’m a psychologist half the time because there’s so much emotion involved.”Some of her clients who previously sought treatment at sports medicine or less specialized practices found themselves engaged in rigorous strength training with little regard to their unique needs. Though overall conditioning is important, understanding someone’s lifestyle and the rigors of a musician’s life are equally important.Note by Note
Rebecca Barton, DHS, OTR, majored in music and married a bandleader, a background that helps her treat her clients. “You understand the schedule, the mentality, the responsibilities,” says Barton, an associate professor at the University of Indianapolis school of occupational therapy. “I think it’s important to be aware of the emotional aspect in your treatment.” Each instrument, level of professionalism, and composer makes different demands. “If someone says they have to play Brahms, I [cringe],” she says (Brahms, like many composers, requires a span of many octaves in a fast tempo).Both therapists advise watching a client play their instrument. Belinsky even makes house calls for harp players and pianists. “Seeing them with their instrument gives you so much information,” she says. Both therapists evaluate posture and position, and then ask about playing schedules, recitals, and test schedules, as well as how playing affects the musician emotionally.Take a Break
A lot of the therapy involves learning to take breaks. For clients who have been unable to play, Belinsky starts with a schedule that requires two minutes of play three times per day with significant breaks in between. The playing time increases two minutes daily as the musician builds strength.But even the most comfortable player shouldn’t exceed 25 to 30 minutes of play before taking a break. Stretching is as important for musicians as it is for athletes, something few musicians know. Prevention is the missing masterpiece in the world of music, Barton says. “If we can educate people about different ways to adapt their playing schedules — taking frequent rest periods, stretching — maybe we can prevent some of these complaints,” she says.A break and stretching might mean simply moving the arms and neck through full range of motion or standing up and walking. Specific instruments, especially strings and piano, may require focused exercises. “Some people might think that’s a no-brainer, but most of us wait until we start feeling the stress to get out of that fixed position,” Barton says. “Do it before.”Soothing Music
Barton designed a trial eight-week injury prevention course for music students at the University of Indianapolis. Six weeks later, a follow-up study found many of the students were developing preventative strategies that worked for them.“Embedding those concepts throughout a curriculum rather than just once makes more sense,” says Barton, whose results were published in Medical Problems of Performing Artists, the peer-reviewed medical journal of the Performing Arts Medicine Association.Belinsky says she’s seeing some teachers incorporating breaks and stretching. Musicians themselves are more open. “It used to be very hush-hush,” she says. “Now musicians collaborate — who[m] to see, what works.”Resources
Barton R, Feinberg J. Effectiveness of an educational program in health promotion and injury prevention for freshman music majors. Medical Problems of Performing Artists. 2008;23(2):47-53.
Hovath, J. Playing (less) Hurt. Minneapolis, MN: Janet Horvath; 2009. www.sudzsalonmpls.com/playinglesshurt/secure/shop.php
Heather World is a medical writer for the Gannett Healthcare Group.
To comment, e-mail oteditor@gannetthg.com.
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