Sports medicine is a well established field within medicine, with everyone acknowledging how important isotonic fluids/exercise testing/team doctors are to the success of athletes. There are however another group of high performance individuals who are neglected by the field of medicine: professional musicians. Everyone seems to know that running is bad for your knees, but what about musicians who constantly employ certain muscle groups? Musicians can in fact be afflicted by a whole lot more than just overuse muscle disorders.
Who looks out for all these musicians? Well surprisingly there’s no special training, so doctors with a passion for musical instruments just started to co-ordinate the care of musicians in specialised centres. Wolfgram Goertz for example leads the out-patients department devoted solely to the care of musicians at the University Hospital Düsseldorf. At a recent lecture, he spoke about just some of the ailments faced by musicians.
As someone who struggled to blow out a clear note on the school recorder I can only marvel at brass and woodwind players. Dizzy Gillespie, the American jazz musician, had a particularly special technique, and his cheeks gives us an idea of the sort of high pressures brass players have to build up when playing. In fact, studies have shown that brass players develop pathologically high pressure spikes in their eyes whilst playing (when this occurs permanently, this condition is known as glaucoma). And for a trumpet player, Dizzy Gillespie had an apt nickname. Dizziness can be a complaint for trumpet players caused by the triggering of an oversensitive vagus nerve (and subsequent drop in heart rate and blood pressure) when the valsava manoeuvre is employed during play.
In every piece of music, there is normally one passage which is especially tricky. The psychological stress occurring in the approach to one of these tricky passages can be huge. Focal dystonia is a sort of cramp and loss of muscle control when practising fine intricate movement, occurring particularly in pianists and violinists. It can occur in difficult passages, even when the rest of the piece can be played perfectly. It is a phenomenon which is often very sensitive to sensory input, so that a violinist having trouble with a passage with the bow may be able to overcome it by simply putting on a pair of gloves. Focal dystonia affecting the facial muscles of woodwind and brass players may respond to the injection of Botox, which serves to weaken muscle spasm. (And as a bonus will obviously get rid of a few wrinkles here and there).
Most of us have experienced stage fright and recognise it as a normal reaction, which can at times be conducive to a good performance. The pathological big brother of stage fright is known as performance anxiety – which can be a crippling condition for musicians. The best treatment for this is cognitive behavioural therapy. Related tremor may be treated with medication such as ß-blockers, although use of this is often frowned upon within musicians. Saying that, used correctly, its probably advantageous to the illicit consumption of alcohol prior to concerts, as practised by some and may help to stop musicians entering the top lists of professions leading to alcoholism.
Sometimes a love-bite can be an innocent case of ‚fiddler’s neck‘. The pressure of the violin as it rests on the neck can cause irritation, swelling and hyperpigmentation of the skin. In some cases, possibly even an allergic reaction to the chin rest.
Knowing to avoid the spot by the speaker at a pop concert comes intuitively to most of us. It’s not so easy for orchestra members to distance themselves from say, the tuba. A good ear is what every musician relies on, yet every musician is at risk of noise-induced hearing loss. Classically, the loudest members of the orchestra are seated at the back and the ‚quieter‘ instruments near the front, so particularly players situated at the front of the orchestra (with their ‚quieter‘ instruments) or in its body will be exposed to a high level of noise. Regularly rotating the position of orchestra members, could lessen the level of noise exposure, but remains something which traditionally classical orchestras don’t really do.
Clearing your throat before giving a talk is something familiar to most of us. But the compulsive desire to clear your throat can become a hindrance to singers. In some cases, the underlying reason for this may be acid reflux from the stomach – the treatment for which may be as simple as prescribing an anti-acid tablet.
‚Saturday night palsy‘ is the term referred to describe the temporary injury of the ulnar nerve as it crosses the elbow often supposedly caused by draping your arm over the end of a couch and falling asleep in an intoxicated state. A violinist, viola or guitar player holding their instrument may suffer a similar fate due to the constantly slightly flexed position of their left arm which my damage the ulnar nerve along its path. This shows itself as numbness and tingling in the inner side of the arm and the little and ring finger.
These cases highlight just a few of the problems faced by musicians. Much like in sport, many injuries can be avoided by warming up appropriately, practising correctly and being aware of the injuries or ailments associated with a particular instrument. What’s clear is that the care of these individuals requires the attention of a truly multi-disciplinary team. Athletes may be over-the-hill at some stage in adulthood, but musicians, we want you to be sharing your talent with the rest of us for as long as you live.