Musculoskeletal Injury and Performance Related Pain

Boyette, Jennifer. “Splinting for Adaptation of Musical Instruments.” Work 25, no. 2 (2005): 99-106.

Boyette explores the use of splinting to aid the thumb in supporting the oboe, forcing the thumb into greater supination where the full pad of the thumb is against the bore of the instrument. She discusses the thumb rest alternative design which extends to follow the length of the thumb to the second phalanx and also nerve and ligament aggravation due to thumb rest pressure or incorrect splint placement.

Dawson, William. “Ask the Doctor.” The Double Reed 22, no. 2 (1999): 99-100.

In the beginning of the “Ask the Doctor” articles, Dawson compiles common medical conditions. He categorizes them as follows: head pain/headache/lightheadedness, nerve compression problems/CTS, muscle strain/tendinitis, head problems/eyes/ears/dental, disease/asthma, and where to seek help. Specific to oboists is a section about instrument support by the right hand.

Dawson, William. “Ask the Doctor: Arthritis.” The Double Reed 26, no. 3 (2003): 89-90.

Dawson approaches arthritis in double reed musicians by looking at the most common form, degenerative joint disease or osteoarthrisis. He itemizes the causes and physical changes that occur in joints as they wear down. “Heberden’s nodes,” joint laxity, and cysts are discussed, as well as other symptoms to be alert for throughout the progression on the disease. Finally he gives options for treatment and ways to work around physical impairments.

Dawson, William. “Ask the Doctor: Arthritis.” The Double Reed 36, no. 4 (2013): 150-53.

An educational piece that looks at osteoarthritis with a focus on the ways it can affect the hands of musicians. Causes, changes, signs and symptoms of osteoarthritis are addresses, including photos arthritic hands. Treatments at early onset and for later stages listed, a good tool for arthritic artists in navigating their medical and performing options.

Dawson, William. “Ask the Doctor: Carpal Tunnel Syndrome.” The Double Reed 22, no. 4 (1999): 65-66.

Dawson defines Carpal Tunnel Syndrome (CTS) and explains its physiological effect on double reed musicians. He describes common symptoms, how to obtain a proper diagnosis, and possible steps to take to remedy the injury like splints, hand therapy, and surgery.

Dawson, William. “Ask the Doctor: Dupuytren’s “Disease”.” The Double Reed 26, no. 1 (2003): 100-101.

Dupuytren’s disease, or palmar fascia, is the thickening of a special type of connective tissue in the palm and palm side of the fingers. Though the understanding in the medical community of why it occurs is vague, Dawson provides some clarity in the form of information on what the abnormal condition is, symptoms that may arise, treatments as well as the pros and cons of surgical treatment.

Dawson, William. “Ask the Doctor: Focal Dystonia.” The Double Reed 26, no.2 (2003): 85-86.

Dawson provides insight into focal dystonia, a termed occupational palsie. He describes the elusive nature of the disease, more often found in the hands, fingers and embouchure. Common symptoms and treatment possibilities are provided, including medication, exercises, psychotherapy, and constraint therapy.

Dawson, William. “Ask the Doctor: Getting Back to Music (Rehabilitation).” The Double Reed 29, no. 2 (2006): 112-14; 30, no. 1 (2007): 88-90.

Article published in two parts. In the first installation, Dawson lists three causes for difficulty in returning to full musical activities: injuries which result in physical limitations that interfere with musician functionality, muscle atrophy and joint stiffness post treatment, and loss of physical strength and endurance after a long period of rest. The second portion of the article provides possible solutions for rehabilitation and prevention of repeated injury.

Dawson, William. “Ask the Doctor: Hand and Wrist Pain.” The Double Reed 34, no. 2 (2011): 131-34.

Dawson wrote in detail on one of the most common injuries for double reed musicians, hand and wrist pain. He assesses the causes, symptoms, treatments for hand and wrist pain as well as recommendations for healing through rest and also include ergonomic improvements to help prevent injury in the future.

Dawson, William. “Ask the Doctor: Hypermobility.” The Double Reed 23, no. 1 (2000): 53-54.

Joint hypermobility is a condition that is hereditary, and is often amplified by environmental contributors. Musicians with a greater range of motion that the standard can be termed double or loose jointed. This can effect a double reed musician’s positioning of fingers on keys and often the middle joint of the fingers can collapse, making fast passages more difficult. Muscle fatigue and strain can result. Musicians can retrain their finger movements, do strengthening exercises, and even splint to promote or restore effective hand-movements.

Dawson, William. “Ask the Doctor: Member’s Queries.” The Double Reed 26, no.4 (2003): 119-20.

Dawson replies to four double reed players letters. The first asks whether Alexander Technique is useful to oboists. Second, why a musician’s hands shake when they play their instrument with four given possibilities: muscle fatigue tremor, postural (static) tremor, benign essential (familial) tremor, and Parkinsonism. The last two questions address aging eyes and arm pain when lifting an instrument.

Dawson, William. “Ask the Doctor: Musicians’ Concerns.” The Double Reed 36, no. 3 (2013): 146-48.

Replying to a number of personal requests, Dawson compiles a column on a variety of health concerns. Abdominal hernias are defined and advice regarding playing post abdominal and oral surgery is given. He names possible causes of pain and numbness in thumb, hand, and wrist.

Dawson, William. “Ask the Doctor: Playing with Hand and Arm Pain.” The Double Reed 21, no. 1 (1998): 89-90.

Dawson outlines the most common causes of pain in double reed instrumentalist’s hands and arms: overuse, nerve compression difficulties and aggravation of a previous problem such as arthritis. He explains what each is, how they manifest, possible triggers, and how to heal and find pain relief for each.

Dawson, William. “Ask the Doctor: Take Care of Those Hands!” The Double Reed 24, no. 3 (2000): 129-31.

Healthy hands are vital to instrumentalists, with even very small problems can have drastic effects. Dawson discusses five components critical for ideal hand functionality: stable support, flexibility, strength, nerve control, and blood flow. Some possible causes of injury mentioned are falling, sports, household injury, and outside employment. Information on steps to take if one of these injuries occur is given.

Dawson, William. “Ask the Doctor: Tendinitis.” The Double Reed 25, no. 3 (2002): 71-72.

Dr. Dawson identifies the difficulties of incorrect tendinitis diagnoses and provides a detailed definition of what it is and what it isn’t. He then explains what happens to the affected tissues, the signs and symptoms of tendinitis, basic and advanced treatments, and rehabilitation and prevention options.

Dawson, William. “Ask the Doctor: Thumb Problems.” The Double Reed 23, no. 3 (2000): 93-94.

The physiology of the thumb and its muscle and ligament functionality in bearing the weight of an oboe is discussed, as well as the effects of ligament elongation, strain and overuse. Tendonitis and arthritis are examined. Dawson warns that pain is a symptom and sign that something is wrong and should be heeded, not be ignored.

Dawson, William. “Ask the Doctor: What’s This Lump on My Hand/Finger/Wrist?” The Double Reed 29, no. 4 (2006): 129-31.

A discussion of the conditions that could produce lumps on hands, fingers and wrists. Ganglions, cysts, tenosynovitis, Heberden’s nodes, Dupuytren’s disease, tumors, xanthoma, and epidermal inclusion are all explained in regards to causes, symptoms and treatments. Photos included.

Dawson, William. “Ask the Doctor: When Acute Injury Interferes with Practice and Performance.” The Double Reed 33, no. 2 (2010): 13-14.

Dawson analyzes the occurrence of acute upper extremity injury as a result of accidents or trauma. Two thirds of the affected patients were under thirty with forty-one percent being a result of a sports injury. Bone fractures and joint dislocations were most common followed by sprains and strains, and then open wounds, some with lacerations of tendons or nerves. Those who were being see for a prior injury were more resistant to treatment. Treatment, return to playing and future prevention are addressed.

Dawson, William. “Ask the Doctor: When Making Music Becomes Painful.” The Double Reed 32, no. 2 (2009): 113-15.

Dawson outlines common physical problems induced by performing and playing. He discusses the physiology of overuse syndrome, its causes, contributors, and results. Muscle strain, awkward body posture, hypermobility, and inflammation are included. He also presents the ideal way to deal with overuse.

Dawson, William. “Ask the Doctor: Wrist Problems.” The Double Reed 37, no. 2 (2014): 161-64.

A detailed look into tendinitis, primarily Carpal Tunnel Syndrome, and ganglion cysts. Anatomic diagrams are included as well explanations of wrist functionality. Dawson discusses the pros and cons of different treatment options.

Dawson, William. “Carpal Tunnel Syndrome in Instrumentalists: A Review of 15 Years’ Clinical Experience.” Medical Problems of Performing Artists 14 (March 1999): 25-29.

Dawson examines histories for musicians who have been treated for Carpal Tunnel Syndrome. Patients are categorized by age, skill level, injury trigger and instrument. Treatments and outcomes are listed and explained.

­­­­­Dawson, William. “Common Problems of Wind Instrumentalists.” Medical Problems of Performing Artists 12 (December 1997): 107-11.

Six major functional topics are considered: support, bodily posture, hand position and use, repetitive activities, embouchure and muscle tension. Attention is given to the right hand thumb support and quick finger movements of oboists as well as embouchure concerns with TMJ.

Dawson, William. Fit as a Fiddle: The Musician’s Guide to Playing Healthy. Lanham, Maryland: Rowman & Littlefield Education, 2008.

For musicians who want to better understand good musical-performance health. Extensively details a large variety of common injuries including, overuse, tendinitis, tenosynovitis, carpal tunnel, nerve pain, and arthritis. Provides treatment alternative and rehabilitation tips and extensive bibliographies for further research.

Dawson, William. “Hand Problems Affecting Performance.” The Double Reed 14, no. 2 (1991): 55-58.

Dawson shares his experience in treating trauma to the musician’s hand and upper extremity. He details the functionality of the muscloskeletal system in the hand and fingers, symptomatic swelling, and deformity due to fracture or dislocation. Voiced is the importance of seeking an orthopaedic specialist, especially one with experience in arts medicine. He outlines what a patient should expect during examination, treatment, and therapy. Possible occasions where there may be a need for surgery are listed.

Dawson, William. “Intrinsic Muscle Strain in the Instrumentalist.” Medical Problems of Performing Artists 20, no. 2 (2005): 66-69.

The small intrinsic muscles of the hand are what move the fingers and in turn, the keys of the instrument, and are responsible for the rapid changes in finger position. Charts with musician level (amateur, student, professional), gender and age, location of pain, and extrinsic versus intrinsic muscle strain. The results of this study suggests that high-level musicians are at greater risk due to overuse, which produces pain and can interfere with practice and performance.

Dawson, William. “Nerve Compression Problems- Arts Medicine for the Double Reed Player.” The Double Reed 15, no. 1 (Spring 1992): 56-58.

Dawson dispels the mystery of nerve pain for musicians. He defines nerves and their functionality, explains symptoms of pressurized nerves and the most likely nerves affected in musicians bodies. The importance of early treatment is emphasized and a variety of possible treatments are outlined.

Dawson, William. “Playing with Pain: Help for Muscular and Skeletal Problems in the Double Reed Instrumentalist.” The Double Reed 11, no. 3 (1988): 35-38.

Common sources of pain for double reed musicians are outlined and explained: overuse syndrome, trauma related injury, trapped or pinched nerves, and arthritis. Dawson share thoughts on the importance of finding a physician with an understanding of art-medicine, assessing an accurate diagnosis, listening to the pain signals of the body, instrument and functional adaptation, and the assistance of an educated teacher.

Fedak, Kee. “To Your Health: Identifying and Overcoming Thoracic Outlet Syndrome.” International Musician 101 (December 2003): 9.

Fedak, a chiropractor, writes for musicians experiencing Thoracic Outlet Syndrome. Aids in recognizing symptoms and understanding the functionality of the neck shoulders, arms and hands, their positioning and their compression of the nerves. Also includes treatment possibilities.

Green, Cynthia. “The ‘Plight’ of the Double-Jointed Oboist.” The Double Reed 14, no. 1 (1991): 67.

Green explains how being double-jointed can hinder technique for oboists. She provides exercises and tips on how to counteract natural tendencies to flatten fingers due to hyperflexibility. Includes helpful photos, ideal for students struggling with flat third and fourth fingers.

Horvath, Janet. Playing (Less) Hurt: An Injury Prevention Guide for Musicians. Milwaukee, Wisconsin: Hal Leonard Books, 2010.

Horvath has compiled extensive research, offering a common-sense approach to musicians’ injuries. She shares her own story and discusses injury prevalence and causes. Topics include: posture, tendinitis, arthritis, TMJ, focal dystonia, nerve pain, stretching and strengthening, stress, hearing loss, rehabilitation, instrument modification, practicing and a large resource list.

Jabusch, Hans-Christian, Sandra V. Müller, and Eckart Altenmüller. “Anxiety in Musicians with Focal Dystonia and Those with Chronic Pain.” Movement Disorders 19, no. 10 (2004): 1169-75.

20 musicians who experience focal dystonia were compared to 20 who experience chronic fatigue and 30 healthy musicians. The goal was to assess whether psychological distress was a consistent indicator of dystonia development, especially in regards to anxiety and perfectionism.

Jones, Saunders, and Christi Hernandez. “An Investigation of the Prevalence of Upper Limb Neuropathies in Different Types of College Musicians by Use of Neurometrix Device.” International Journal of Biology 2 (January 2010): 132-42.

Jones and Hernandez present the results of medical research regarding repetitive stress injuries, especially carpal tunnel, amongst musicians. Oboists are not directly referenced but the woodwind analysis and symptom recognition is applicable. Warm-up routines and alertness for tingling are recommended.

Markison, Robert E., Amy L. Johnson, and Morton L. Kasdan. “Comprehensive Care of Musical Hands.” Occupational Medicine 13 (July-September 1998): 505-511.

Different contributors to hand pain in musicians are explored, including the shortcomings of the “no pain, no gain” philosophy. The authors outline many treatments frequently utilized to treat hand pain. Preventative measures are also explored and theories by other arts medicine advocates are compiled and compared. Markison et al conclude that performance arts medicine is becoming more widely understood and musicians are typically motivated to take care of themselves and follow medical advice.

Martín López, Tómás, and Joaquín Farías Martínez. “Strategies to Promote Health and Prevent Musculoskeletal Injuries in Students from the High Conservatory of Music of Salamanca, Spain.” Medical Problems of Performing Artists 28 (June 2013): 100-106.

Advanced music school students were presented a course on health and musculoskeletal injuries and how to evaluate possible risks associated with their instruments while another group of students was not. Included were medical problems of musicians, warm-up habits, postural hygiene, effective prevention strategies, and different treatment options. When evaluated at the end of the school year, the students in the experimental group had improved their body awareness by 91% and the frequency of their injuries decreased by 78%, while there was no improvement in the students from the control group. A strong testament to the importance of health education for music students in injury prevention.

Manchester, Ralph. “Playing Healthy, Staying Healthy: What Do I Need to Know about Musculoskeletal Issues?” The American Music Teacher 64 (October/November 2014): 30-32.

Manchester provides thoughts on self-care for continued, pain free musicianship and lower injury rates. Included in his recommendations are a 5-10 minute break per hour, exercise, healthy diet and sleep, modifications to instruments, and working with a knowledgeable teacher.

Nelson, Reid T. “Wrist Pain from Oboe Playing.” The Double Reed 19, no. 1 (Spring 1996): 80. (Verified 2/28/2015, original print article HBLL. One page only.)

Nelson briefly writes of his experience with wrist pain, difficulty finding solutions, and trying a neck strap, primarily a testimonial. Article submitted to The Double Reed in hopes of helping others with similar pain.

Niblock, Howard. “Stop Oboe Hand Position Problems before They Start.” The Double Reed 18, no. 3 (Winter 1995): 89-90.

Niblock makes a case against the common technical problem of a flattened third finger in the left hand. By learning to play with a curved and flexible third finger, an oboists can relieve tension and improve dexterity in left-hand pinky fingerings.

Nolan, William B., and Richard G. Eaton. “Thumb Problems of Professional Musicians.” Medical Problems of Performing Artists 4 (March 1989): 20-24.

A hand surgeon’s perspective on thumb related injuries in musicians. He does not specifically refer to the oboe but the contents are highly applicable with details on diagnosis and treatment options. Highlights de Quervain’s tenosynovitis, basal joint laxity, and ulnar nerve neuropathy. Includes x-ray images and anatomical diagrams.

Norris, Richard. The Musician’s Survival Manual: A Guide to Preventing and Treating Injuries in Instrumentalists. St. Louis, Missouri: MMB Music, Inc., 2011.

Norris, a musician and physician, has written a collection of articles with the intent better educating musicians about health concerns and the prevention of music induced medical ailments. The topics included are overuse injuries, nonsurgical treatment of upper extremity, disorders in instrumentalists, the neck region, Thoracic Outlet Syndrome, back and shoulder problems, carpal tunnel, de Quervain’s, lazy finger syndrome, therapeutic exercise, and returning to play post injury.

Ro, Jenny I. “Risk Factors for Musculoskeletal Disorders among Performing Musicians.” PhD diss., University of Massachusetts Lowell, 2006.

Ro surveyed professional musicians belonging to the San Francisco and Hawaii musician’s unions in an attempt to call attention to the occupational risk for development of upper-extremity musculoskeletal disorders. Extensively researched, breaking down participants by age, instrument, practice, posture, pain symptoms, stressors, medical conditions, work history, additional occupations and activities, reasons for career termination, and daily performance habits.

Rott, Sydney. “Taming Dystonia: An Oboist’s Story.” The Double Reed 26, no. 2 (2003): 82-84.

Rott shares her personal experience with dystonia in her left hand. She tells about her interactions with physicians, therapy, and exercises, all which contributed to eventually helping her brain recognize all of her fingers again and retrain their basic functionality.

Taylor, Jillian. “Pelvic Floor Dysfunction in Oboe Playing.” MM thesis, Queensland Conservatorium Griffith University, 2003.

Taylor shares her research and experience with pelvic floor dysfunction when playing post childbirth. It is broken into three sections: the inter-related nature of oboe playing with pelvic floor dysfunction, methods of breathing and muscular support of the air-stream, and the electromyographic results of a test study. Discusses the effect of hormonal imbalance in muscular healing. Many diagrams of the musculature in the body which support breath control are included.

Walker, Ellen Marie. “Predictors of Performance Anxiety and Playing-Related Pain in University Music Students.” MS thesis, Eastern Michigan University, 2002.

Walker focuses on the interrelation of playing-related pain, anxiety and stress levels in university musicians. She ascertains that stress is a trigger for pain. Includes a self-report checklist that could be useful for self-monitoring of pain and anxiety levels.

White, Darrow Edward. “Focal Dystonia among Selected Instrumentalists and Other Playing-Related Impairments: Implications for Music Education.” PhD diss., Boston University, 2008.

Motivated by his own experience with focal dystonia, White delves into the details of the disorder as well as other playing related injuries. Along with the results of his own research, an extensive bibliography is included at the end.

Watson, Alan H. D. The Biology of Musical Performance and Performance-Related Injury. Lanham, Maryland: Scarecrow Press, Inc., 2009.

A valuable resource for instrumentalists. Watson provides knowledge to assist musicians in better understanding the demands on their bodies with an in-depth look at biological principles performance. Of specific interest are the first three chapters: introduction to the tissues of the body, posture and the back in musical performance, and the shoulder, arm, and hand- structure problems. Watson also includes sections on focal dystonia and hearing problems.