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MASSAGE FOR MUSICIANS diminishing a musician's playing-related musculoskeletal problems. Self-care becomes more motivating when we realize what a difference it can make. The good news is that muscle pain is treatable. As doctors Janet G. Travell and David G. Simons say in Myofascial Pain and Dysfunction: The Trigger Point Manual, "When patients mistakenly believe that they must 'live with' trigger point pain because they think it is due to arthritis or a pinched nerve that is inoperable, they restrict activity in order to avoid pain. Such patients must learn that the pain comes from muscles, not from nerve damage, and not from permanent arthritic changes in the bones. Most important, they must know it is responsive to treatment. This gives the pain a new meaning. When these patients realize the twin facts that their pain is myofascial and is treatable, their lives take on new meaning and they are started on the road to recovery of function."4 How do muscles get into trouble to begin with? Situations that create overwork and injury in muscles are: small repeated actions (muscles thrive on variety); intrinsic domination (small muscles working when larger muscles are better suited to the task); static holding (muscles don't get rest or blood flow); and mechanical disadvantage (using energy for less than optimal positioning and posture).5 The Breathe Rest Imagine Move (BRIM) self-care chart, which follows on page 91, provides a general list of goals for muscle rescue. Where there is constriction of blood vessels and loss of oxygen and waste removal, our goal is to increase circulation with movement. Where there is tissue starved for oxygen, our goal is to increase the supply with occasional deep breaths. Where there is muscle fatigue from repeated actions, our goal is finding even minutes of rest during activity. And finally, where there is mechanical disadvantage from awkward postures, our goal is to bring the body into alignment as much as possible with adaptive devices and body awareness. This list of goals is presented for therapists to share with their musician clients. What's so encouraging is how forgiving muscles are, how small moments of rest, recovery, movement, and adjustments in position can be so restorative. These things, especially when combined with well- balanced, moderate exercise, and massage therapy, can create a healthy atmosphere for muscles, the delivery system for the musician's art. As the muscle is put into any of the above situations, it becomes constricted, develops trigger points (a focus of hyperirritability), and can constrict the blood vessels running through it and entrap nerves. Tendons of the muscles also can become irritated or inflamed from the repeated friction during use. Of course, playing an instrument involves many of these situations and the nature of the beast is overuse of muscles and tendons. Sitting in the concert hall that evening, I resolved to observe and analyze T.M. to detect any reason for her previous pain and discomfort. While a noble intention, as the music began and the emotional power of Brahms filled every millimeter of this immense hall, I could not seem to focus on the nuances of her mechanics when presented with the beauty that flew from her fingers. The music was moving, powerful, commanding. It would not let me disassemble the whole experience into fragments. I stopped watching T.M.'s graceful movements, content only to close my eyes and let the music move me to my very soul. Through discipline, science, and attention to detail, the work with T.M. had resolved her pain. Now, as I sat transfixed by the beauty of the sounds, I was inspired by the elevation of science and discipline to mastery and artistry, a truly moving experience at the very essence of art. 90 massage & bodywork january/february 2008 therapist since 1977. He owns a clinical practice in Champaign, Illinois, which employs sixteen therapists. In addition, he is the founder of Precision Neuromuscular Therapy and has taught hundreds of seminars across the United States and abroad. His company, NMT MidWest, Inc, has been conducting numerous research studies in soft-tissue therapy. He can be reached at doug@nmtmidwest.com or at 407 W. Windsor Road, Champaign, IL 61820. Douglas Nelson has been a massage across the United States as an instructor for Precision Neuromuscular Seminars. She maintains a private massage practice in Cincinnati, Ohio, and has recently produced a CD titled Relaxation Into Sleep (www.meditatetosuccess.com), which has been featured on Delta Air Lines. Jan Kiener is an LMT and travels L'Équilibre Massage (in both Boulder and Fort Collins, Colorado) and focuses on repetitive strain injuries. As a clarinetist, she directly understands the challenges that face musicians. Lieberman has written and published other articles on alternative and complementary healthcare. She teaches introductory massage courses at Colorado State University. Deborah Lieberman, MA, CPNMT, owns NOTES 1. Richard Lederman, "Neuromuscular Problems in Musicians," Neurologist 8, no. 3 (May 2002): 163–74. 2. Janet Horvath, Playing (less) Hurt—An Injury Prevention Guide for Musicians (Kearney, NE: Morris, 2003). 3. Barbara Paull and Christine Harrison, The Athletic Musician: A Guide to Playing Without Pain (Lanham, MD: The Scarecrow Press, 1997). 4. Janet G. Travell and David G. Simons, Myofascial Pain and Dysfunction: The Trigger Point Manual (Hagerstown, MD: Williams & Wilkins, 1983), 31. 5. Doug Nelson, Precision Neuromuscular Therapy: Upper Extremity Manual (2000), 47.