Self Treatment: Myofascial Release

Fascia is connective tissue, a webbing that surrounds every muscle, bone, and organ of the body.  In essence, it is what holds us together.

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In the case of injury or over-exertion, fascia becomes tight and dense, shortening muscles.  This contributes to inflammation, muscle imbalance, localized tenderness, and irritated nerves.  Habitual poor posture and repetitive stress injuries have cumulative effects on the body as fascia contracts.  Keeping fascia soft and pliable helps to both prevent injury and stimulate healing.

This understanding has been groundbreaking through my most recent shoulder dislocation (loose ligaments- it’s genetic.)  Now I was not only stretching muscles and realigning ribs, I was softening supportive tissue.  In two weeks of focused myofascial release I saw more results than I had in the previous two months, a fast forward button to healing.

Trigger Point Therapy

Trigger point therapy is an excellent way to soften fascia and deeply stretch irritated muscles. Trigger points are small zones of contracted muscle knots that radiate pain.  Releasing them can help realign muscles as well as decrease inflammation.

You can use any lacrosse ball, tennis ball, or therapy ball.  If you want to be able to use the ball over your shoulder as in the photograph below, put the ball in a knee-high, tube, or soccer sock.

Carrying a heavy backpack with books, reed tools, music, and my oboe takes a large toll on my already inflamed and unstable shoulders.  Trigger point therapy helps me release tension, keep swelling down and promote healing.

Meet my newest therapy tool, I cannot express how much I adore this thing.  You do not need this brand of ball to get the same results but I thought it best to share for it’s convenience.  The bungee rope and addition of the tiny ball for more focused work on acute tension points have been helpful.

A couple tips for trigger point work:
1.  Aim for 45 seconds in one spot, enough time for the muscle to release but not too much.  Longer can restrict blood flow and possibly cause the muscle to spasm.

2.  Rolling in a circular motion is my favorite but you can roll back and forth over the spot or just apply steady, direct pressure.  Experiment and find what your body responds to best.  Here is a diagram of trigger points in the neck and back:

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This webpage includes a brief video tutorial on how to release tight and tender muscles in the neck and shoulders using the floor instead of the wall.

Palmar Fascia

An oboist needs to maintain pliability in their hands, in the palmar fascia.

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Repetitive stress from long hours of reed making and performing, especially if there is tension in the hand and forearm, can lead to tightening of the fascia in the palm of the hand.  Repetitive strain on the hand leads to contracting and even spasms in the palmar muscles.  Myofascial release can also help with carpal tunnel symptoms.
Relief can found by releasing the soft tissue by gently rolling a ball on the palm of the hand in a variety of areas (see the video below).  Always gently!  An oboist’s hand is a valuable commodity.
A little bit of release can have big results.  You just may find your fingers moving more fluidly the next time you fly through Polovtsian Dances or La Scala.
 

As with anything injury related, when in doubt see a physician.  I am not, nor do I profess to be, a health specialist.

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Kinesio Tape for Oboists

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You may have noticed different colored tape on athletes in the last summer Olympics.  This magic tape is used to help support muscles, relieve strained tendons, improve body alignment and promote healing by stimulating blood flow.

Musicians are athletes too.  Our movements may be smaller but they are similarly repetitive and at times result in strain and damage.  While tape may not be the cure all, it is a fantastic tool to add to your musical health and wellness toolbox.

Note that I am not a physician.  Please consult a doctor for accurate injury diagnosis and treatment.  Tape is best applied with the help of a trained physical therapist. And no, I am not endorsed by these brands.  Just a satisfied customer.

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KT Tape has been my favorite brand for a couple reasons: the material is more breathable and it can retain its strength for 3-4 days unlike some other 100% cotton options.  Rock Tape is another brand that deserves notable mention.

Taping Techniques for Oboists

1) Tape can be used to alleviate carpal tunnel distress.  The application of tape improves blood flow through the wrist joint, lifts pressure off the median nerve, and supports the carpal ligament.  A combination of massage, stretching and taping in early stages of carpal tunnel can alleviate symptoms and help musicians avoid more severe damage and invasive surgery.

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Note: The tape has a difficult time sticking to the skin in the palm of the hand.  To avoid this issue, clean the surface of the skin with rubbing alcohol before applying tape and cut finger holes in the tape so it can wrap around to the other side of the hand.

Visit this page for a video tutorial on taping for carpal tunnel.

2) Tennis Elbow is an RSI tendinitis triggered by repetitive gripping between the thumb and first two fingers.  The swollen tendons manifest pain through the top of the forearm in a diagonal from the thumb to the elbow, at the knob on the elbow where the tendons attach to the bone, and up the back of the arm.  Along with massage and rest, taping can help relieve strain on the tendons and wrist extensors.  As before, clean the surface of the skin with rubbing alcohol before applying tape.

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For an example of the use of tape for tennis elbow, click here.

3) Shoulder stabilization.  As oboists, if we aren’t aware of our body alignment or we don’t take time to strengthen and balance opposing muscles, injuries develop.  If we play hunched over with shoulders falling forward, we are primarily using the pectoral and bicep muscles.  The deltoid and trapezius muscles become weak and neglected in comparison.  In my case, it led to shoulder sublexation, a type of dislocation where the ball of the upper arm bone slid forward out of the socket of the scapula and slipped back.  My injury was accelerated by loose ligaments and carrying babies, so don’t think that slouching guarantees something as intense as shoulder dislocation.  But small imbalances become large imbalances as they are neglected.

If shoulder instability is an issue for you, taping can help retrain your shoulders to return to their natural alignment when combined with strengthening exercises. There were days where my joints were so loose, it felt as if my shoulders were literally taped to my body and that was the only reason they were still attached!

Shoulder stabilization taping techniques are demonstrated here.

Health and Healing,
Erika

Hearing Loss

Whether you are a young musician with perfect hearing, sitting in a large orchestra setting with trumpets blaring behind you, or you are more advanced in years and your ears aren’t quite what they used to be, it is important to take time to ensure that you are preserving and maintaining good auditory health.  While Beethoven, once deaf, may have found a way to feel the music by cutting off piano legs and feeling vibrations in the floor, that would prove to be a more challenging pursuit for oboists.  That, and it drove him mad in the process.  Not the best route for maintaining a successful music career.

Instead, here are some links to a highly published author in auditory research in relation to music:

The Musicians’ Clinic was established by Dr. Marshall Chasin, Director of Auditory Research, along with Dr. John Chong, Director of Musician’s Injuries, in Hamilton and Toronto, Ontario.  The golden find on this site http://www.musiciansclinics.com/articles.asp is a collection of 35 articles written by Dr. Chasin on auditory health divided into five categories: music and the prevention of hearing loss, music and hearing aids, language and hearing aids, acoustics, and other.

Dr. Marshall Chasin has another website http://marshallchasinassociates.ca/.   View the FAQ page for answers to music related questions concerning hearing.  The collection of 35 articles available for download in pdf format mentioned previously is located here, on the article page, as well.

Finally, http://hearinghealthmatters.org/hearthemusic/ is the blog written by Dr. Chasin with new entries posted each week.

Musician’s Health Advice from Scotland

Patrice Berque, based in Glasgow, Scotland, is a professional musician turned trained physiotherapist with a focus in Performing Arts Medicine.   “He is involved in research in the field of Performing Arts Medicine, and had publications in “Medical Problems of Performing Artists” (USA), “Médecine des Arts” (France), “Physiotherapy” (UK), “Manual Therapy” (UK), “Neurology” (USA). (1)”

Berque’s “advice download” page at http://musicianshealth.co.uk/ offers a variety of perfomance health related information.  Links of particular interest are:

Exercise for Musicians- Play Fit, Not Flat! by Bronwen Ackermann
The benefits of cardiovascular fitness for strength and endurance and the importance of carefully planned weight training is addressed.  Specifically mentioned is balanced shoulder muscles and the need for strengthening muscles between the shoulder blades to balance the overworked rotator cuff and pectoral muscles.  Stretching, yoga, pilates and balance programs are recommended.

Physiotherapy and Dystonia by Patrice Berque
Berque has a specific interest in focal hand dystonia, having been motivated to pursue his medical research by dystonia onset.  He briefly discusses constraint-induced therapy through the use of splints and motor control retraining.

Preventing Muskuloskeletal Injury (MSI) for Musicians and Dancers
A 135 page resource guide written by Dan Robinson, Joanna Zander, and B.C. Research for SHAPE (Safety Health in Arts Production and Entertainment) in Vancouver, British Columbia.

Some papers Berque has written are available for download with permission from the publisher at http://www.musicianshealth.co.uk/biography.html#publications.  Also, a series of resources are available on the links page: http://www.musicianshealth.co.uk/links.html

(1) Quotation from Berque’s bibliography page at http://musicianshealth.co.uk/biography.html.

In Defense of Musician’s Health

It is rare that I meet a musician who has not developed at least one instrument specific physical ailment.  And yet it also a topic rarely discussed.  When I encountered my own oboe-induced physical roadblocks, the amount of searching, time, and financial resources required was astounding.

My goal in making this bibliography public is to help those who are searching for answers to health questions unique to the double reed world.  I am not medically trained, though I am fascinated by the mechanics of the human body.  And in no way is this information intended to replace the need for medical help from professionals.  But being well informed as a patient can expedite both the hunt for answers and healing time.

Each page on the blog is a different portion of the bibliography, divided generally by topic with over 190 sources.  If you have difficulty finding any of the original sources, I have archived where each was found and would be happy to forward the information.

I will continue adding online resources and links over time as well.  Recommendations welcome.

This a non-profit blog, a free musician’s health education for all.  Please forward this site to anyone who may find it useful!