Scribd Logo
Upload

Welcome to Scribd!

  • Emailing Healthy Hands A Primer in Injury Management For Guitarists (PDF) - 731672217

    Uploaded by

    AndresFelipePalaciosR1.
    12 views9 pages

    Original Title

    Emailing Healthy Hands a Primer in Injury Management for Guitarists (PDF)_731672217

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    12 views9 pages

    Emailing Healthy Hands A Primer in Injury Management For Guitarists (PDF) - 731672217

    Uploaded by

    AndresFelipePalaciosR1.

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 9
    Healthy arise A Primer in Injury Management for Guitarists by Serap Bastepe-Gray As instrumental musicians, we spend many hours during che day in non-normative postures, engaged in repeating similar movements to achieve our dested sound outcomes. No wonder injury is common ‘among musicians, The guitar, along with che piano, harp, ute and violin, have been associated with particulaey high injury rats. Driven by the paradigm shift toward prevention and wellness in the healtheare industry, much has been written about how to prevent injuries in musicians, athletes, and the general workforce who use theit arms in a repetiive fashion within the daily routine of their work, Most ofthe information available alchough useful in increasing injury awareness, is generalized, overemphasies strengthening and stretch- ing, is loosely—ifat all —correlated with sound-elated outcomes, and perpetuates the misconception that if you do everything right. you will never have ro deal with an injury. ‘he reality is chat injury can happen to any of us, and often does, 40 itis critical chat we acquire knowledge and skill in injury fist aid and injury management so that we can help diminish che efecs of an injury on our meaningful engagement in music making. Unfor tunately there is @ gap in the information available about what a musician can do to achieve this. Ths is no coincidence because ‘musicians’ injury rehabilitation is «complex process and there are no ‘tablished, evidence-based sandards for care of injured musicians. In this article, I will ery to answer the most frequently asked questions chat 1 have encountered from the musicians with whom 1 have worked in helping them return to performing cheir instrument. What is injury? Defining what constitutes injury is not easy. The online Merriam-Webster Medical Dictionary defies injury as ure, damage or los sustained.” Our bodies often respond to injury with an inflam ‘matory reaction in an attempt to repair damaged tissues. Repeated ‘mcro-injury and repair cycles may ead to eurnlative damage to our tissues and may cause sructual changes. In the field of performing-ats medicine, the injuries sustained playing an instrument are called playing-related musculoskeletal dis- orders. Paying-related injuries may lead to pain, swelling, redness, fnumbness, cngling, loss of strength (weakness) of agility, loss of dlenterigy and restricted range of mosion (sifines) How do tissues get injured in playing an instrument? Ie is important to have a basic knowledge about how things ‘work in our bodies and how injury occurs in playing an instrument, because without this spe of understanding, itis impossible to have commonsense notions about injury prevention and the process of rehabilitation, Although the exact mechanisms of injury may be slightly diferent in each case, microscopic tears due to workloads that exceed the tensile capacities of soft tissues—especially where muscles turn into tendons and cendons attach to bones—seem to be the initial ‘vent, Sometimes, repeated movements in suscained and asvhvard postures and positions, or repeated movements atthe end-range of ‘our joints amplitude of motion, can cause soft tissues such as tendons to bend and rub around stationary structures, leading to micro-tears and inflammation. Iris not only muscles and tendons that are vulner- able o injury in playing an instrument, Petipheral nerves are vulnera- ble especially when passing through confined musculoskeletal spaces. Sustained postures combined with inflammation in neighbor- ing structures might increase the pressure in these small canals and damage the nerves overtime. What are aenre, subacute, and chronic injuries? ‘These are verms used by healthcare professional co designate the phases ofthe ssue-epar process based on the time aftr an injury has ‘ceurted. Iis important ro know these because the care ofthe injured tissue requires diferent approaches ror phase to phase. Acute injury (new pain or a flare-up) usually indicars fresh iicroscars. In this phase, the rssues ae eying to “glue” themselves together and to plug the capillaries chae ate oozing into the micro-tear aes. Thus, rubbing, pushing, and pulling of the injured dssues + through moving them excessive, applying workloads to them, (or massaging or stretching them) in this phase isnot recommended since it may disrupe this gluing” proces. Similarly, applying heat to Idea, since heat enlarges blood vessels and increases the “oozing” inc the miero-tae areas. In the subacute phase, the tissues ate stil vulnerable, but they can withstand small amounts of pull and push. In this phase, genie and gradual activity is usually reintroduced to begin reconditioning of structures and to maintain range of motion Suboptimal tsue repair during the fist ewo injury phases or re- peated episodes of reinjury may lead the injury into the “chronic” phase—ivhere pain and discomfort never go away completely, and flare-ups are common. acutely injured area isnot a goo 24 Soundboard Vol. 40 No. 2 werwguitarfoundation.org What are specific playing-related factors that may increase risk of Injury in guicarises? ‘Alchough the mechanisms of injury are applicable for most in- serument playing, ichelps to know the specific and unique sis Factors ‘associated with our own instrument. An understanding ofthe unique issues that may lead to injury in playing the guitar is prerequisite to inductive and deductive reasoning, which may not only keep our own hhands healthy, but may also help to instruct our friends’ or students ideas about upper limb health 1, High Working Muscle Tension Pushing down more chan necessary to get a clean sound with cour lefchand fingers, or compensatory grabbing of the fretboard to correct poor targeting in a lateral shift are common biomechanical jssues in guitarists, In players with underdeveloped right-handlei- hand independence, an increased working muscle tension in one hand can cause increased tension in the other: for example, loud passages and crscendos cause increased workload in the eft hand more than necessary to maintain a clean sound In order to function optimally, our forearms and hands need the support ofthe larger muscles of our trunk and shoulders. Decreased engagement of these large muscles due to les-than-optimal bio- ‘mechanical habits, or due to decreased strength or Rexibility ofthese large muscles, may cause our arm and forearm muscles to work at higher-than-necessrycensions (Certain techniques unique to gutat, such as bares, slurs, raygue do—as well as fast scalar passages and large shifts—requte higher ‘working tension, Playing repertoire that contains 2 large number of these sudden-load techniques may resule i cumulative work chat can exceed tissue capacities. Ergonomic issues such a8 high string action and high anxiery. and frustration also lead to high working muscle trsion. 2, High Resting Muscle Tension In guitarists, high resting muscle tension most often results om insufficient micro-unloading: release of working tension in one muscle unit before activating the next muscle unit. This biomechanical ineff- ‘ciency can also resule fom inadequate development of Finger indepen- dence in right or le hand. Playing repertoire with concentrated rapid passages inthe upper positions where the string action is high and where chere is limited time to fally release and re-press the scrngs, as well a psychosocial factors such as anxiery or stage fight, increase resting muscle tension, ‘An increased resting muscle tension inevitably eads to compensa- tory increae in working muscle tension, thus eumulatively increasing the overall workload ofthe involved tissues. 3. Sustained Isometric Contractions In cases where we need to keep 2 large spread of our fingers, such 4s in passages with Finger exxensions or when we playin lower post sions with an ill-fitting guitar, the small muscles in our hands end up in almost constant muscle contraction, tension, as well as psychosocial factors such as anger, ‘Our forearm muscles, which supinate (palms up) and pronate (palms down), are optimally relaxed when our palms are facing each other. The farther away fiom this optimal position, the more fsometic contraction in either the supinator or the pronator is needed. Play- ing with the Fretboard positioned in low angles (lower than forey-ive degrees with horizontal plane) and keeping the left hand in scalar Postion all the time (Fingertips aligned with one string) may resul in increased sustained supination in the left hand. Excessive roration toward the thumb inthe right hand may result in increased sustained pronation. ‘The asymmettical posioning involved in playing the guitar involves isometric contractions of certain lage and medium-sized ‘muscle groups in shoulder, neck, and trunk, In time, these prolonged ‘asymmetrical postions may lead to imbalance of these large muscles due co shortening of the muscle fibers. When such an imbalance hap- pens chese lange muscles cannos engage in their supporting actions, thus increasing the burden on the forearm muscles to accomplish the movements necessary to playing the guitar ‘When we play the guitar and remain within our skill evel, our large shoulder muscles contact just enough to stabilize our arms, Play~ ing passages that exceed our skill levels rigger compensatory sustained isometric contraction of these shoulder muscles. Ths is a common issue especially in che right shoulder, which is alteady in a suboptimal posture because of the placement ofthe right forearm over the edge of the lower bout of the guitar. 4. Joint Alignment and Range Issues ‘The pulley mechanisms in our forearms work more effcienly i the muscles and tendons are aligned propery. Playing with ulnar (coward the pinky side) or radial (toward the thumb side) deviation atthe wrist are common biomechanical issues in guitarists that may lead to excesive wear and tear in tendinous structures. This may also narrow the canals through which the nerves are passing o reach our hands. Similarly, movements around joints are optimal within the mid range of these joins. Movementat che outer edges ofa joint range not ‘only require isometric contractions to hold the joint in that end-range, but also forces the structures to move while they arc overstretched. Playing with excessive Alexion in the left or right wrist is a common issue, overstretching the extensor tendons at the back of che hands and changing the dimensions ofthe “tunnel” at the wrist 5. Sudden Increase in Practice o Performance Time or Intensity ‘When we are preparing for competitions, when we ate learning a Jorof new repertoire, when we have a busy tour schedule or when we ae in the “zone” and just enjoying ourselves, we increase our practice or playtime on the guitar. Sometimes we are aware of whet we are doing, bus choose to increase the hands-on time, and sometimes we are not even aware—untl something stars hurting www.guitarfoundation.org Soundboard Vol. 40 No.2 25 ‘APrimer in Injury Management 6. Increased Work Load on Arms and Hands Due to Other Daily Activities Ta today’s word, the expectations of society from musician far ‘exceed the making of music. We are expected to have entrepreneur spits, sel advocacy skills, efficient work habits, fic (preferably chis- cled) bods; insurmountable energy, impeccable networking skis, and ‘thos of other qualities cha are being reflected on us ina world diven by the business model. Consequenty itis easier than ever for mus- cians to get injured lifing weights or typing in our zeal to keep up with the demands ofthe world that are cangentially related co making 7. Inadequate Rest Cycles Muscles and soft rissues need adequate rest in order to recover from the wear and tear of musculoskeletal activity Fatigue and time course of recovery have been studied in athletes; depending on the volume and the intensity ofthe active, ie might take up to forty-eight hours for the muscles and soft tisues co fully recover from exercise.” Rest eycles of various durations (such as a five-minute rest every thiety minutes, one day off every week, alternating shore days with Jong days et.) are important in allowing tissue recovery and maintain- ing the natural capacity of the muscles and soft rssues. Competition preparation, busy rehearsal or cour schedules or lack of sleep, as well as auditional dil, esure, academic or professional activities like weight lifting, yping, or careying equipmene) may inerfere with rest eyeles and diminish tissue capacities, Even if we are playing with optimal biomechanics, certain aspects of playing che guitar, by the instrument’ very nature, require us to sustain asymmetrical postures and suboptimal alignment and range. A good example is our left elbow, which remains in constant feexion around ninery degrees during play. One of the peripheral nerves the ulnar nerve, curves around our funny bone through a canal (cubical unnel) and remains under increased pressure during the time ‘we spend playing the guitar beause che optimum angle a che elbow for lowest pressures inthis tunnel is around 130 degrees. Ths adds to the importance of adequate rest cycles and brings about the consider- ations of positioning in rest periods to compensate for the effects of ‘the playing position 8. General Health and Fitness Issues Tissue capacities are also influenced by nutrition, hydracion, and general fitness levels. Due 0 our intrinsic motivation and experience of flow in musical asks, we spend a lot of time focused on music making and tend to forget to take care of our bodies and to make sure we eat right, hydrate, and move around to keep fit. This may lead 1 decreased general cardiovascular and musculoskeletal conditioning and decreased availability of nutrients necessary for muscle activity and tssue-repir ces. 9. Passive Suetching Stretching is a very common theme in injury prevention pam- phlets. Fexbilcy of ou soft vssus is important; however, we cannot “seretch the discomfort out” of our limbs. Asa matter offic, excesive seretching can injure or reinjure us by pulling on the tissues and caus- {ng micro-ears. ‘We also need ro be ava of the mechanics of stretching. There are two types of streching: dynamic and pasive stretching. Dynamic scretching is stretching a tsue within a movement, through active muscle action, such 28 in Tai Chi or when a newborn baby stretches afer waking up. Passive stretching, on the other hand, i using anoth- ce extremity oF a sationary prop to stretch the tissue by pulling with ff pushing on it. Seudies show that athletes who engage in passive seretching before achltic activity tend to get injured more frequently? have pain ane discomfort in my shoulder arm, forearms, band, o finger Am Linjured? Pain is « complex experience, bue generally it isthe warning mechanism of the body. It usually indicates that something is not right. We all know that if we go to the gym and expose our mus- cles, usually larger muscles, 10 relatively high workloads, that our muscles ache the nextday. This called delayed onsee muscle soreness (DOMS), DOMS results from accumulation of lactic acid in large muscles during exercise. The pain comes several hours later as the tissues are cooling down, and the soreness is usually inthe muscle belly rather than tendons or joints. DOMS goes away when the lactic acid is physiologically cleared from the muscles, We can sometimes experi- cence DOMS afer a slight increase in practice time, or if we practiced new repertoire with concentrated high-Load techniques suchas bares, Alterating light and heavy practice days and maintaining a healthy level of cardiovascular fitness can be hell in minimizing DOMS. ‘On the other hands rapid-onsec pain that develops as we are play- ing the guitar or right after we sop playing is indicative ofan acute, playing-related injury and requires immediate atention. Ics important to note that people experience pain and injury Jn unique ways, and iis sometimes hard to explain these sensations. Some people describe their sensations following injury as, “T was playing the guitar and my arm started co fel extemely tired all of sudden,” or "My hands sarced feeling stiff” In some cases, when the injury is cumulative in natute, the pain and discomfort can increase gradually over time rather than having a sudden onset. Sometimes rather than pain, we can fel just @ nagging dscomfore in a partc- lar area, IF che nerves are involved, we can fel tingling, numbness, electiclike sensations, or we can feel that our fingers are not moving the way they used to, Narn Gamba. ii De eer Sac of Fatt! Spot Gamba, thi 26 Soundboard Vol. 40. No.2 www ifoundation.org pga HL, Haman Kits, What shoul I do if think Lar injured playing the guitar? Gan I heep practicing? Scientific literature emphasizes tha resting the painful area and refraining from pain-inducing activities are the fist seeps in failitat- ing tissue repair in new injuries. In fesh injuries (new pain) or acure flare-ups of chronic injury (recutrenc pain), it is best co stop hands (on activity on the guitar, bur continue mental practice (visualization) dling the incl dssue-xepai and inflammation-contol phase. Below isan algorithm of what todo: 1, Stop and cool down De Raymond Wittstadt, a leading hand surgeon, an instructor of orthopedic surgery at the Johns Hopkins Universicy, and a 2013 Baltimore magazine Top Doctor who leads the Musicians’ Clinic at the Cutis National Hand Center, emphasizes that musicians need pay close atention to any pain and discomfort, especially fit is new pain, recurrent pain, and persistent pain He recommends that the firs thing to do if you think you might be injured while playing an inserument is to stop and cool down the area by resting that limb, and even running cold water over the affected area for about five to ten minutes, Then rest the involved exeremicy for abou twenty to half an hout.IFthe pain goes away completely, gently try out how he area wil fel with some light practice. Stop immediately if you fel the pain coming back and cool down the area. Move on tothe fis id protocols. 2. Begin injury first-aid cool-down protocols Recommended injury frst aid in athletes involves two inital protocols for tissue-repair facilitation and inflammation control: the PRICE protocol, which then becomes the MICE protocol. Both of the prococols involve cooling of the sssues. The modified versions of these protocols (See Figure 1 on Page 28) are helpful in limiting inflammation and allowing vissue healing in musicians, especially during che initial stages ofthe injury or in flare-ups ofa chronic in- jury. A recent study indicates that cooling down the tisues follow ing vigorous use helps not only to decrease the pain and discom- fort, but alo speeds up the recovery from postexercise fatigue and rerun of function in the fast and slow cwitch fibers of the involved ‘muscles. A recent study indicates that as compared to rest, massage and

    You might also like