Académique Documents
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Musculoskeletal injuries
Cynthia C. Carsley
B. Sc. Physiotherapy
M. Sc.(A) Occupational Health
Musicians websites
Part 1: Introduction and Background. Preventing
Musculoskeletal Injury (MSI) For Musicians And Dancers:
A Resource Guide
http://www.shape.bc.ca/resources/pdf/part1.pdf
Part 2: Musicians. Preventing Musculoskeletal Injury (MSI)
For Musicians And Dancers: A Resource Guide
http://www.shape.bc.ca/resources/pdf/part2.pdf
Musicians and injuries. Engineering Electronics Shop
http://eeshop.unl.edu/music.html
Daum, M.C. Musculoskeletal problems in musicians.
Center for Safety in the Arts
http://www.sierranevada.edu/life/safety/musicsaf.htm
Hearing loss*
Environmental techniques
Earplugs, monitors etc.
Tinnitus
Pitch perception
problems
* Chasin,
Chasin, M. Musicians & the Prevention of Hearing Loss.
Loss.
Hearing Review 1999. See www. musiciansclinics.com
Skin problems*
Vary widely
Point of contact
Bruises, calluses, cuts,
abrasions, ulcers, eczema
(bow resin)
62% violinists & violists
under chin (left)
32% string players
27% wind & brass
Dental problems*
Periodontal disease
Malocclusion
Loose teeth
Psychological*
Social pressure
Fatigue
Increased adrenaline
Anxiety
Financial instability
* Part 2: Musicians. Preventing Musculoskeletal Injury (MSI) For Musicians And Dancers:
Dancers: A Resource Guide
Anatomy
Muscle
Connected to bones by
tendons (at either end)
Elastic
Provides movement and
stability
Fascia
Anatomy
Tendon
Anatomy
Joint
Anatomy
Bursae
Anatomy
Cartilage
Anatomy
Nerves
Cordlike structures
transmit electrical
impulses to and from
body parts they control
Anatomy
Peripheral nerves
Travel from cranial nerves in brain or spinal
Motor nerves
Send signals to muscles
Sensory nerves
Transmit pain, temperature, position,
and
pressure in skin, muscles & joints to the brain
Anatomy
Intervertebral disc
and menisci
Fibrous cartilage
Provide extra cushioning
Musculoskeletal disorders
Musculoskeletal disorders
Pain
Unique for each individual
High threshold in performers
Performers normalize pain
No pain, no performance
Fear label musician with injury
Lack of resources to subsidize and prevent early
treatment
Musculoskeletal disorders
Pain
Defensive mechanism intended to protect
May not appear during activity responsible
May occur during sleep
May appear suddenly or gradually over months
Pay attention to when? how long?
influence on ability to perform ADLs?
Level I
Pain occurs after class, practice, rehearsal or performance,
but the musician performs normally
Level II
Pain occurs during class, practice, rehearsal or performance,
but the musician is not restricted in performing
Level III
Pain occurs during class, practice, rehearsal or performance,
and begins to affect some aspects of daily life. Musician alters technique, duration.
Level IV
Pain occurs as soon as the musician participates in class, practice, rehearsal,
or performance , and is too severe to continue. Many aspects of daily life are affected.
Level V
Pain is continuous during all activities of daily life, and the musician is unable
to participate in class, practice, rehearsal, or performance.
Focal dystonia
(Sternbach 1994)
(Chong et al 1989)
String players
Certain wind
instruments:
oboe
french horn
flute
require sustained extension
to hold instrument while
allowing fingers to curl into
position for fingering.
De Quervains tenosynovitis
Pain in tendons at base of thumb & thumb side of
of forarm
Painful to move thumb away from hand
Painful firm grip or twisting motion
De Quervains tendinitis
Oboe players
Clarinet, flute players use
thumb extensors to
support instrument
Drummers extreme
flexion & lateral motion
of wrist with rapid
deceleration at impact
Keyboard & thumb
under ascension
(Chong et al 1989; Zaza 1998)
Lateral epicondylitis
(tennis elbow)
Epicondyle at elbow is
anchor point for several
muscles
Pain at elbow, forarm or
wrist
Medial epicondylitis
(golfers elbow)
finger movement
Violin, viola,cello
String bass
Bassoon
Pain:
tension on posterior
ligaments & small muscles
local swelling
muscle spasm
nerve compression
Orbicularis oris
Sciatica
Environmental aspects
Physical demands
Personal characteristics
Temperature
Awkward postures
Confined space
Forceful exertion
Physical fitness
(strength, flexibility,
endurance)
Layout of space
Repetition
Nutrition
Equipment
Long-duration activities
(inadequate rest)
Posture
Layout or configuration of
equipment
Contact stress
(sharp edges)
Addictive substances
(tobacco, alcohol, narcotics)
Surfaces (floors)
Vibration
Psychological stress
Lighting
Administrative
Union
Funding agency
Regulatory body
Company manager
Early development
School board
Music instructor
Parent
Artistic
Director
Composer
Conductor
Musician
Technical
Sound engineer
Stage manager
Technical director
Piano tuner
Venue design
Equipment designer
Interior designer
Architect
Purchaser
Challenging schedule
Poor diet
Pressure to perfect
Performance anxiety
*Zaza and Farewell 1997; Paull and Harrison 1997; Kella 1997
** Zaza and Farewell 1997; Kella 1997; Norris 1993; Chong et al 1989
Zaza 1994
practice
Cold
blood flow to fingers
lubrication tendons & joints
nerve conduction velocity
Poor lighting
Compromises ability to read music
Compromises playing posture
Eye strain
Warm up
blood flow
Warms muscles and joints
Gentle smooth motions x several minutes
An aerobic warm up for 5 minutes : rapid walk, slow jog, skipping
Slow long notes beginning practice, rehearsal, performance
Gradual increase to duration & intensity of practice
Stretching controversial
Note by note
Movement by movement
Assists cognitive aspects of learning
Enhances speed of motor
learning
Reduces physical practice time & physical risk of injury
high
Avoid excess dead space at top of piano keys
* Norris 1993
Add a cushion
Stack chairs
Wooden blocks under
chair feet (careful)
Footrest (phonebook)
Depends on instrument
Maintain low back curve
Foot width
Lumbar pillow
Wedge cushion
Lift back legs of chair
Wide base
level or below
Lower eyes rather than
head
Directly in front
drums &
saxophones
REST
ICE
Blood flow & sensation
15-20 minutes
Not directly on skin (frozen peas in damp towel)
No creams, balms, rubs
Do not use to numb pain to keep performing
Musician
Health care providers
Teachers
Equipment providers
Instrument providers
Furniture providers
Question period