Musicians are a unique population that rarely receive recognition for their ‘athleticism’. Musicians exercise their muscles much like a sporting athlete. They work through hours of practice (6 to 8 hours a day is not an uncommon day) then perform at events in some cases under enormous stress/pressures or unfavorable environments.
The muscles that musicians use most are fine motor muscles. The fibers of these muscles are slightly different from the larger muscles, though still have the capacity to fatigue and strain with overuse.
When there is an injury came up with a musician we have to get back to their highest level of function not the back to normal life. A novel exercise program was specifically designed for professional orchestral musicians to target the performance-related musculoskeletal disorders reported in this occupational group.
Most of the program was based on fundamental sports rehabilitation principles resulting in a program that consisted of
️activating the muscles concerned with stability and satisfactory postural control of the region in the early stages.
added external perturbations or resistive loads in the middle stages, and the late stages
Exercises were used that both increased muscle endurance demands and were applied in a specific functional position relating to common patterns of movement during instrumental performance.
Common injuries
Performance-related musculoskeletal disorders(PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians.
Other common musician injuries,
Overuse injuries.
Neck and back pain.
Muscle imbalance problems and movement dysfunction.
Nerve entrapment syndromes.
musician’s cramp
Conditions related to Playing posture & ergonomics of playing instruments.
Physical risk factors for injuries
sustained high levels of playing or sudden increases in playing load (overload)
Lack of rest breaks in rehearsals and private practice
Poor posture and biomechanics
Incorrect instrumental technique
Musicians’ poor health education
ROLE OF PHYSIOTHERAPY
Assessment of the injury
based on careful, thorough physical and musical instrument-specific assessments as well as specialist clinical examination.
Identify the cause of the injury
Treat through an individualized treatment plan
▪️Correct the playing posture
▪️ Demonstrate the correct technique of using the instrument
▪️ Relieve stress on joints and muscles
▪️Improve control of pelvic floor muscles will improve vocal control too.
Prevent further and re-injuries
Identify the modifiable risk factors and develop a plan to prevent them.
Enhance performance
The physiotherapist's goal is to get the musician back to their highest level of function with improving muscular endurance, strength.
Provide health education and advice for Musicians
Educate them about the posture, techniques, taking breaks, risk factors for the injuries, and how to avoid them.
Musicians suffer a high incidence and severity of performance-related musculoskeletal disorders. Neck, shoulder, and back injuries are not uncommon.
Neck injuries
Progressions of cervical spine exercise therapy strengthening the deep neck flexors and extensors were adapted for musicians. In the final stages, varying degrees of resistance were applied to the neck from a variety of angles to load the deep neck muscle system in an attempt to replicate the challenges of maintaining a healthy neck position while sustaining the weight of
instruments. Neck problems needs Cervical spine rehabilitation, Improving muscle efficiency by reducing hypertonic muscles (sternocleidomastoid, levator scapulae, upper part of the trapezius) Shoulder rehabilitation - Scapula stabilization and rotator cuff endurance exercise.
Shoulder injuries
A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control. This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning.
Spinal injuries
The early stages of the spinal series consisted of low load activation of the lumbar multifidus. Later stages progressively integrated the lumbar multifidus into a range of more functional activities with appropriate use of load and a variety of external perturbations to mimic the movements used during a performance.
Abdominal injuries
A focus on activation of the abdominal muscles during commonly prescribed Clinical Pilates exercises was included, progressing into more difficult stages using an unstable base of support. Finally, these exercises were adapted into more functional activation patterns in both sitting and standing.
Hip injuries
A focus was placed on the endurance and strength of the gluteal muscle group, including hip abduction and external rotation exercises. The intermediate stages combined these exercises with upper body movement. The final stage incorporated the elements in the previous exercises in all three planes of movement. Low Back Pain is reduced by, Optimising functions of the lumbar multifidus, Re-training of proper transverse abdominis and internal oblique activation (wind and brass players)
Lumbo-pelvic control is important to support dynamic upper body movements, such as those involved in instrumental playing.
Hip – strengthen the gluteal muscles to improve proprioception and control of lower limb alignment.
Advises from physiotherapist's point of view
Throughout the playing, a musician should follow the correct posture.
Musicians should carefully plan their private practice schedules as well as monitor their overall playing load to minimize the potential.
For musicians’ frequent breaks assist in reducing the constant strain and load bearing on the joints. As well as allowing recovery of supporting musculature and fine control muscles of the fingers and the lips.
Before the long practice sessions, it is important to consider nutrition and hydration.
Early identification of injury will lead to preventing secondary problems focusing on immediate treatments.
Following principles of first aid like resting the injured area, icing the injured area, applying compression with elevation would reduce the effect of the injury preventing worsening the situation.
References
https://www.rhpphysiotherapy.com.au/expertise/musicians-2/
http://www.physiotherapy-for-musicians.com/
Githmi Ishara
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