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MASSAGE FOR MUSICIANS "I just don't understand why this is happening. I used to have pain, but I have been studying with this great teacher and I changed my technique to a more efficient movement pattern. I just can't have this pain right now!" T.M. looked at me with eyes that revealed her intensity, intelligence, and deep concern. She has been playing the viola since she was three—music is her whole life. It is her dream and passion; T.M.'s deep emotion is evident when she plays the instrument. No longer just a collection of notes, in the hands of T.M., the music cuts right to the heart. Her playing is masterful, moving, true art. Now physical pain threatens all that she has worked for. In the short term, it threatens her participation in an upcoming orchestra recital, of which she is the principal violinist. In the long term, pain may destroy her performing career. T.M. is not alone. Music injuries are being recognized increasingly as a potential hazard of the physical nature of playing instruments. While high profile artists, including pianists Gary Graffman and Leon Fleisher, have suffered music injuries from overuse, numerous other musicians of all levels and disciplines have suffered enormously, too. In the past, there were few resources for meeting the special needs of musicians. Resources are available for athletes, but students involved in the arts are not treated in the same way. There are perhaps two reasons: one is that the revenue available for the arts is generally modest; the other is that students and their teachers do not think of themselves as upper extremity athletes. The physiology of artistry is often overlooked. When student musicians hurt, rest seems to be the only option. Student athletes are immediately given strategies to get them back on the field as soon as possible, whereas musicians are consistently told to take a break from playing. In one sad but humorous encounter, a student, getting his master's degree from Juilliard was asked by his doctor if perhaps he would consider switching instruments to help his hands. With quick wit, he immediately asked the doctor if he had ever thought about being a veterinarian. When musicians hurt, three questions must be explored. First: is this pain the result of ongoing processes, such as faulty technique? Second: is this pain a result of inappropriate muscle use, such as playing without warming up, playing too long, lack of stretching, etc.? Third: what is the underlying history of this particular pain? Technique issues can be the most important aspect of healthy playing, yet finding the right teacher is not an easy prospect. There are few physiologically- based methodologies in music education. For playing stringed instruments, the Rolland method is a fine example of striving for the most elegant and physiologically-based approach. One of the authors knows of a fine piano teacher who used a full human skeleton, placed next to the piano during lessons, to instruct students in the physiological processes, as well as the musical and physical technique. Finding such teachers who understand physiology is not easy. Musicians must be evaluated by experts in their chosen instrument who can help them play with maximum physiological efficiency. Injury is a substantial reason for students dropping out of master's programs in music performance. If the professors who attain an advanced degree have never struggled with injury, their lack of personal experience with performance injuries leaves them ill-equipped to help injured students. Most therapists who treat musicians are not experts in each instrument; meanwhile, instructors often tell students just to play through the pain, leading to disastrous consequences. "She was amazing," T.M. told me about her new instructor. "After so many years of playing, she completely changed the way I play the viola. I guess, if you look from the outside, I am not sure you could see the changes. To me, the changes seem radical. It took some faith and patience, but I play better, use less energy, and the pain I felt completely disappeared. That is, until now," T.M. added with remorse. Knowing that T.M. was obviously in the hands of a fine teacher, I resolved that technique was not an issue. This made my job infinitely easier. I could focus on other issues. "How much have you been playing lately?" I asked. "About as much as I always do. I practice a lot," she added. "Actually, I guess that is not true," she corrected. "In addition to my normal practice routine, I have had this big orchestral concert coming up and we are doing a Brahms symphony. It is beautiful but there are some difficult passages, which I have had to play over and over to master. Also, my friend is doing her doctoral recital and I told her I'd play for her, which happens to overlap with my own recital coming up, which I have also been preparing for. I guess I have been playing a lot more than I usually do," she confided. A STRUGGLE FOR SUPPORT Researching the topic of musicians and pain, we were struck by how taboo a subject it appears to be. Though this problem is widespread, apparently musicians fear being blacklisted if they admit they are struggling with pain. In a May 2002 article in The Neurologist, author Richard Lederman details the frequency of playing-related problems in musicians. He describes a survey completed in 1988 by the International Conference of Symphony and Opera Musicians (ICSOM) in which 2,212 instrumentalists responded to a questionnaire about their medical problems. This number represented about 55 percent of the members of the 48 orchestras surveyed. Of the participants, 76 percent listed at least 84 massage & bodywork january/february 2008