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The long thoracic nerve passes between the scalene muscles and crosses the top of the shoulder. Excessive pressure from a guitar strap across this region can compress the muscle and lead to motor impairment of the serratus anterior muscle, a crucial part of shoulder function. 3D anatomy image, Primal Pictures Ltd. copyright, www.primalpictures.com. dysfunction and motor impairment of the serratus anterior muscle (Image 1). Finally, standing and sitting for every day with the muscles of the mouth tightly gripping the double reed of the instrument. These constant muscle contractions are way more than the body was designed for. It doesn't always take repetitive motion to cause performance-related injury. Instrument size or weight, for example, may be a key injury factor. Consider a young student learning to play the cello; this instrument's size and weight may be more than the young person's body is adapted for, and trying to reach around and hold it up while playing can lead to overuse injury. Even for adults, some musical instruments are quite heavy, and simply holding them in position can be a significant strain. With the way some rock musicians flail their guitar around, you would never guess that it is heavy, but a guitar can weigh more than 10 pounds. That weight is held up with a strap across the upper trapezius. Constant pressure from that strap can put adverse compression on the long thoracic nerve, leading to shoulder long periods are a cause for frequent complaints of low-back pain, as well as leg and foot disorders. All of these biomechanical factors add up to potential performance-related injury. Add in poor posture, bad ergonomics, and lack of proper skill development, and you can have a host of issues that plague those bringing musical enjoyment to our communities. Let's take a look at a few specific conditions that routinely affect musicians. FOCAL DYSTONIA Focal dystonia is a condition occurring with increasing frequency in musicians, although you do not see it often in the general population. It is caused by a central nervous system dysfunction and can be set off by chronic muscular overuse. The condition is still not thoroughly understood, but muscular overuse apparently leads to involuntary muscle contractions (spasms) of the overused muscles. The spasms result from neurological misfiring in the sensorimotor cortex of the brain. Those suffering from focal dystonia can experience serious pain and motor dysfunction that prevents the individual from being able to perform. Often the condition arises as a sudden inability to use a key body part necessary for playing. A famous case involved renowned keyboardist Keith Emerson of Emerson, Lake, and Palmer, who suffered from focal dystonia in his hand and had to cancel a tour and major concert appearances. Atlanta jazz saxophonist Rick Bell suffered from focal dystonia in his jaw muscles from extensive hours of playing just as his career began to take off. The condition got so bad he was forced to stop playing for 10 years and was only able to resume years later with the addition of a mouth splint, which helped prevent a recurrence of the condition over the rest of his career. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 101