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Article:
JAMES R. OESTREICH c.1996 N.Y. Times News Service
edited for this website 

Musicians' Physical Risks Become More Apparent

In the supposedly genteel realm of classical music, skirmishes in the eternal struggle between valor and discretion generally take place on the field of self-esteem. Performers who reach beyond their physical grasp may suffer embarrassment, even ignominy, but seldom anything more concrete. Or so it has seemed. But when the Kronos Quartet recently canceled a performance of Morton Feldman's grueling six-hour String Quartet No. 2 at the Lincoln Center Festival '96, it brought into clearer focus the element of physical risk always present in music making. 

For pianists, who grapple incessantly with instruments many times their size, the hazards may be self-evident. In any case, the widely publicized right-hand disabilities of Gary Graffman and Leon Fleisher have brought those dangers to light. But every instrument, every musical pursuit, carries bodily risk. Some of the more prominent victims of late have been string players: Peter Oundjian and Reinhard Goebel, violinists, each of whom suffered permanent loss of fine motor control in his left (fingering) hand, and David Leisner, a guitarist, who sustained a similar injury to his right (plucking) hand. 

All of these disabling hand injuries fall into a category called ``focal dystonia,'' which covers a wide range of overuse or repetitive-stress symptoms; fingers may involuntarily splay or curl into the palm, often with no pain. Although much remains to be learned about focal dystonia, it has widely been thought to be incurable. Leisner begs to differ, having healed himself over the past five years. He regained full use of his right hand just this summer. The Kronos problems were, by comparison, early and mild. These players performed the Feldman in a shorter, mere 4 1/2-hour version six times during the 1980s with, they reported recently, some discomfort. 

Then, a decade older, they tried to prepare the full six-hour work, and two of them, they said, experienced significant back and shoulder pain. Musical performance is, in part, a physical test. It requires, in at least some parts of the body, good basic agility and coordination, finely honed skills, intense conditioning, brief warm-up and, especially for Wagnerites or Feldmanites, considerable stamina. ``Small-muscle Olympians,'' Dr. Kyle Pruett called musicians at the Norfolk Chamber Music Festival in Connecticut last month, as large-muscle Olympians were toppling records in Atlanta. Pruett, a clinical professor of child psychiatry at the Yale University School of Medicine, was speaking at the festival's second annual conference on music and medicine, sponsored by the school's section on sports medicine and the Yale Summer School of Music. 

The conference provided musicians with valuable counsel on physical matters from a battery of Yale doctors of various specialties. But it was also intended to familiarize doctors trying to extend their expertise from sports medicine to the performing arts with musicians' specific problems and concerns. Pruett provided fascinating insight on the relationship between the seemingly disparate psychologies of classical music and sports. Although sports are thought by some to instill an unhealthy sense of competitiveness, classical music, with what Pruett called its ``early expectation of perfection,'' may impose on its practitioners an even harsher and more punishing ethic. Athletes have it relatively easy. For them, Pruett said, ``performance is about winning, not being perfect.'' This psychological drive toward perfection undoubtedly lies close behind many a musician's physical problem. 

 ``Being a musician can be an accident,'' Goebel said in quaintly accented English, impatiently steering the conversation back toward music. What he seemed to mean was, ``Being a musician is an accident waiting to happen.'' In the case of Oundjian, who recently resigned after 15 years as first violinist of the Tokyo String Quartet because of a similar problem in his left hand, the accident was an error in the routine maintenance of his instrument, leaving the vertical angle of the strings minutely altered. This altered, too, the length through which Oundjian had to depress the strings. Compensation, again. It is a danger athletes learn early on, and it is becoming recognized as perhaps the most baleful concept in the annals of performance injury, A rapid change in routine can be almost as harmful. 

Leisner. Now 42, Leisner, who calls himself ``an aggressive player'' to begin with, developed focal dystonia in 1984 after about a year and a half of playing unusually difficult repertory. A program of Bach, Glass, Ginastera and Villa-Lobos, in particular, he said, was musically pleasing and substantial but ``an utter disaster anatomically.'' 

For five years, he made a frustrating round of doctors and therapists. Then he returned to the guitar on his own, laboriously regearing his technique to pluck almost exclusively with thumb and index finger. In 1992, Leisner said, he ``almost intuitively'' involved the larger muscle groups in his arm, shoulder and back in the stroke, and began almost immediately to regain control of his fingers, one by one. ``By '93, I was able to use the middle finger most of the time,'' he said. ``By last fall, the ring finger was virtually completely back, and as of this summer, it is 100 percent.'' Leisner's happy ending is so far rare. Injuries like his appear to be on the rise, as performers set themselves more demanding schedules and more difficult repertory; as they try to marry an innate or learned perfectionism to new standards of athleticism, which are increasing everywhere. The medical community is beginning to rise to the occasion, too, with ventures like the one in Norfolk. And increased communication may bring hope to sufferers elsewhere. 

Cubital Tunnel Syndrome in Guitarists and Preventive Measures

This syndrome typically affects guitarists in the left hand (for right handed individuals - the opposite would apply for left handed people). Because the guitarist uses the left hand for playing the fret board. 

Since the ulnar nerve passes between the muscles that perform flexion of the wrist, bending of the fingertips, and lateral deviation of the wrist (used in stretching the pinky to reach the higher frets), a typical bar chord can affect the muscles surrounding this nerve. With constant overuse of these muscles, they can become inflammed, or actually form "microtears" at the attachments to the elbow. The swelling involved can start squeezing down on the ulnar nerve, causing the symptoms mentioned above. This is also why bending the forearm will worsen the complaints. The ulnar nerve becomes stretched upon flexion of the elbow. If the nerve already is being pinched, the stretching is going to amplify the symptoms.

Prevention

Before you play and during your breaks, increase blood flow to the forearm and hands by stretching and performing self-massage to the area. (You may want to visit your library or bookstore and look into some massage techniques - these help to increase the blood flow to your arms and flush out toxins.)

For complete prevention, invest in an occasional massage by a professional massage therapist. Also, check with a doctor of chiropractic to make sure the alignment of your neck, shoulders, and elbows is correct to allow proper nerve flow to the muscles and skin.

Reference:
T. Jameson, , D.C., C.C.S.P. Dr. Jameson is the director and owner of Bayshore Chiropractic Holistic Health Center for Performing Arts Injuries in California

Dystonia - What is It? click the logo for the 
International Federation of Musicians for this health info

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