Repetitive Stress Injuries in Musicians

Introduction

Musicians face unique physical challenges in their pursuit of musical excellence. The demanding nature of their craft often leads to a high prevalence of repetitive strain injuries (RSIs). Studies indicate that up to 80% of professional musicians experience playing-related musculoskeletal disorders at some point in their careers [1]. These injuries can significantly impact performance quality and threaten career longevity, making it crucial for musicians and healthcare professionals to understand and address these issues effectively. Clients with these conditions often seek out the help of massage therapists.

Repetitive Stress Injury

Several factors contribute to the development of RSIs in musicians. Prolonged practice sessions without adequate breaks can lead to muscle fatigue and overuse. Awkward postures, often dictated by the instrument being played, can place undue stress on certain muscle groups. For example, violinists and violists frequently experience left shoulder and neck pain due to the asymmetrical playing position [3].

Additionally, instrument-specific movements, such as the rapid, repetitive finger movements required for pianists or the embouchure (mouth) control needed by wind instrumentalists, can contribute to localized strain and potential injury. These injuries typically affect the soft tissues, including muscles, tendons, and nerves.

One of the more common conditions, especially affecting those playing stringed instruments, is Carpal Tunnel Syndrome (CTS). This disabling problem results from compression of the median nerve in the wrist, causing numbness, tingling, and weakness in the hand. When playing many string instruments, the position of the left hand is in significant wrist flexion. The wrist flexion position causes median nerve compression by narrowing the space within the carpal tunnel. At the same time, there is often rapid movement of the left-hand fingers, which causes fast and frequent engagement of the finger flexor tendons in the carpal tunnel. The repetitive tendon engagement in these compromised positions is what leads to many cases of carpal tunnel syndrome in musicians.

Focal dystonia is a neurological condition that causes involuntary muscle contractions and disrupts the fine motor control necessary for playing an instrument. This condition, often affecting the hands, fingers, or embouchure muscles, leads to abnormal postures, cramping, or uncoordinated movements, making it difficult to execute precise techniques. Musicians with focal dystonia may find their ability to play certain notes, chords, or passages impaired despite no apparent weakness or injury.

Tendinosis involves degenerative changes in the tendon’s collagen fibers, often resulting from repetitive microtrauma over time. This condition frequently affects the forearms, wrists, and hands of musicians. Most instruments require significant independent and rapid movement of the fingers, which is a recipe for chronic tendon overuse. The pathophysiology of tendinosis includes a breakdown of the tendon’s normal collagen structure. These changes lead to a thickened and weakened tendon with reduced tensile strength and elasticity. For musicians, this manifests as localized pain, stiffness, and potential loss of fine motor control – crucially disrupting precise instrumental technique.

These conditions affect both everyday players and professionals. My former saxophone teacher developed focal dystonia in his jaw from years of playing with chronic tension in the jaw muscles. Keith Emerson, the virtuoso keyboard player of the group Emerson, Lake & Palmer, developed nerve damage and focal dystonia in his hands. This impairment was very difficult for him to overcome, and some have noted these health concerns likely played a part in his depression and eventual suicide. Lionel Richie has spoken about experiencing tendonosis in his hands, which affected his piano playing. Elton John has also dealt with tendonosis in his hands at various points in his long career as a pianist. And Eddie Van Halen reportedly struggled with tendonosis in his hands and wrists, particularly later in his career.

Recognizing the early signs of RSIs prevents their progression and facilitates effective treatment. Initial symptoms may include mild discomfort or fatigue in the affected area, often improving with rest. However, as the condition progresses, musicians may experience persistent pain, weakness, or loss of fine motor control. These symptoms can significantly impact performance quality and can interfere with daily activities. In severe cases, musicians may be unable to play their instruments for extended periods, potentially jeopardizing their careers.

Massage Treatment

Massage therapy offers a valuable approach to treating and managing RSIs in musicians. The hands-on nature of massage allows for targeted treatment of affected tissues, promoting circulation, reducing muscle tension, and improving overall tissue health. Several specific massage techniques have shown particular efficacy in addressing musicians’ RSIs.

Superficial myofascial release and dermoneuromodulation (DNM) approaches (also commonly called skin dragging) can be highly effective in treating RSIs. These techniques focus on gentle manipulation of the skin and superficial cutaneous nerves, which can help reduce pain and improve tissue mobility. By targeting the sensory nerve endings in the skin, DNM can influence the nervous system’s pain processing, potentially leading to long-term pain relief.

Trigger point therapy is another valuable tool in the massage therapist’s arsenal. Musicians often develop myofascial trigger points – hyperirritable spots in skeletal muscle associated with palpable nodules in taut bands of muscle fibers. These trigger points can cause localized pain and may refer pain to other areas. By applying targeted pressure to these points, massage therapists can help release muscle tension and alleviate pain [4].

Active engagement techniques, a cornerstone of my teaching approach, particularly benefit musicians. These techniques involve applying massage while the client performs active or passive movements. This approach enhances proprioceptive awareness, improves muscular coordination, and can help retrain movement patterns that contribute to the RSI. For example, a violinist with shoulder pain might receive massage to the upper trapezius while slowly raising and lowering the arm, mimicking the bowing motion.

While massage therapy can be highly effective in treating RSIs, prevention remains the best strategy. Proper technique and posture are crucial in minimizing the risk of injury. Regular breaks during practice sessions allow muscles to recover and prevent fatigue-related injuries. Complementary practices such as yoga or the Alexander Technique can help musicians develop better body awareness and movement patterns. Other treatment options include retraining the brain’s motor control through physical therapy, altering practice habits, or, in some cases, using medical interventions such as botulinum toxin injections to reduce muscle overactivity.

In conclusion, repetitive strain injuries pose a significant challenge for musicians, potentially impacting performance quality and career longevity. By understanding the nature of these injuries and implementing effective treatment strategies, including targeted massage therapy techniques, we can help musicians maintain their health and continue to share their artistry with the world. If you’re a musician experiencing persistent pain or discomfort, don’t hesitate to seek professional help. Early intervention can make a significant difference in your recovery and long-term well-being, and massage therapy can be an excellent part of that strategy.

For massage therapists who want to learn more about treating pain and injury conditions in musicians and other occupational disorders, be sure to check out our Orthopedic Medical Massage courses at:
References:

1. Kok LM, Huisstede BM, Voorn VM, Schoones JW, Nelissen RG. The occurrence of musculoskeletal complaints among professional musicians: a systematic review. Int Arch Occup Environ Health. 2016;89(3):373-396.
2. Altenmüller E, Jabusch HC. Focal dystonia in musicians: phenomenology, pathophysiology, triggering factors, and treatment. Med Probl Perform Art. 2010;25(1):3-9.
3. Steinmetz A, Seidel W, Muche B. Impairment of postural stabilization systems in musicians with playing-related musculoskeletal disorders. J Manipulative Physiol Ther. 2010;33(8):603-611.
4. Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain. 2015;31(2):159-168.