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TECHNIQUE @WORK Fretting Over Musicians' Injuries? By Whitney Lowe Repetitive stress injuries (RSI) are pervasive among musicians. Hours and hours of practice over many years take a serious toll on the body and can lead to a wide variety of soft-tissue pain and injury conditions. When we look at an athlete, we automatically assume heavy physical demands from both practice and performance. However, the intense physical demands associated with musical performance are often overlooked. Soft-tissue therapy is a welcome relief to those who overwork their Editor's note: This is the first article in a series that will profile specific occupations and the musculoskeletal injuries common to them. Stay tuned to ABMP.com for information about upcoming related webinars. bodies in an effort to bring entertainment to the rest of the world. Let's explore some common biomechanical factors for a number of conditions affecting musicians, then discuss three specific conditions in detail. BIOMECHANICAL FACTORS The primary injuries musicians experience can be classified into two broad categories: repetitive motion disorders and excessive isometric loads. While both may be considered RSI, the way they develop is different. A large number of musicians' injuries occur to the upper extremities because this is the region of the body primarily used to play instruments. However, many players also experience low-back and lower extremity issues as well, due to long hours sitting or standing, or in the case of something like Stomp (a musical performance troupe), using the legs to play instruments. Repetitive motion disorders occur as a result of performing a particular movement again and again. Consider the number of individual finger flexor motions involved for a pianist to play a single piece of music, then consider how often that piece of music was practiced. Watch a percussionist, like a marimba or xylophone player, and you will see an exceptionally large number of rapid elbow flexion and extension movements as they strike the keys with a mallet. A bluegrass mandolin player holds a small instrument and is frequently playing passages involving rapid picking, requiring the hand be moved swiftly in both radial and ulnar deviation. The muscles acting on the wrist that perform these motions are not ideally suited for this type of activity. These types of repetitive motions overload the muscles and soft tissues. Chronic muscle tightness is another performance-related type of injury. Numerous pathological disorders result from long periods of constant isometric muscle contraction. These are not so much repetitive motion disorders, but are considered RSI because of the repetitive nature of the muscle contractions involved in them. The flute player who must hold the instrument out to the side while playing engages in constant isometric contractions of the upper trapezius and shoulder abductor muscles. The violinist who grips the instrument between the chin and shoulder must hold it with the neck flexor muscles in a constant state of contraction. The drummer's wrist and hand flexor muscles must stay in a continuous contraction to hold the sticks. Similarly, the symphony oboe player spends hours 100 massage & bodywork january/february 2012