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Treating
musicians with RSIs: six suggestions for GPs - "Learn
to trust physical examination," advises Dr Tick.
- Consider
the patients as a whole and look further than the location of the pain.
- Consider
alignment therapies, such as Alexander Technique, Feldenkrais or yoga.
- Be
aware of the intrinsic emotional nature of the patients, says Dr Chong. "That's
what makes them good artists. It also makes them vulnerable to stress."
- Be
aware of technical limitations. "There are certain ways in which you play
a particular instrument," says Dr Tick. "To suggest something that may
be better for the body but would be drastically unconventional... will not be
done."
- Consider general lifestyle factors such as
diet, exercise, smoking and substance abuse.
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Six days before her big recital, pianist Daisy
Mackenzie massages her aching wrists and looks despairingly at the sheet music
in front of her. "It hurts too much. I'll never learn that Prelude in time,"
she laments. Repetitive strain injuries (RSIs) strike musicians of all stripes,
from world-famous soloists like concert pianist Murray Perahia, to students like
Daisy at the cusp of a promising future. How should doctors approach musical RSIs?
"Playing a musical instrument isn't like getting
beaten up by Ty Domi," says Dr John Chong, medical director of the Musicians'
Clinics of Canada. He says doctors should take the time to look beyond the obvious
injury and ask what caused the problem. "Is it something external, in the nature
of the activity? Or is the patient presenting in a situation of depletion?" Physical
and psychological factors both trigger RSIs and require different therapeutic
approaches, says Dr Chong. "If the injury is playing-related then we can deal
with the straightforward biomechanics — changing angles, reducing force,
changing practice, changing diet and exercise. That's the easy stuff." But
what if the musician, like so many struggling artists, is depressed? "Then I am
medically obligated to start dealing with that stuff," says Dr Chong. The depressed
musician may be recovering from a hypermanic burst of creativity — after
overworking they may now be crashing and feeling the ill effects, he says. PAIN
IN THE NECK
While stress and depression can contribute to RSIs, one
must still keep an eye on physical factors. "Repetitive strain injuries are characterized
by the level of injury exceeding the body's ability to heal," says Dr Heather
Tick, of Toronto's RSI Clinic. She believes that most RSIs are caused by myofascial
disorders of the neck, and like Dr Chong, she says that the doctor must look further
than the location of the pain. "When I see someone
who complains of an elbow problem or a wrist problem, I always examine their shoulders
and their neck," says Dr Tick. "And almost always, if it's a chronic injury there's
damage there too. We look for the patterns of nerve damage. It's very, very subtle,
though. Unless you do a careful physical examination, you'll miss the injuries."
According to Statistics Canada, 2.3 million Canadians
suffer from RSIs. While the exact number of Canadian musicians with these injuries
is not known, studies suggest that the numbers are high and growing. A 2002 study
published in the Italian Journal of Anatomy and Embryology found that 65%
of pianists surveyed had an RSI. Another survey, published in 2001 in the Annales
de Readaption et de Medicine Physique, found that a whopping 76% of responding
musicians suffered from at least one RSI. It seems unlikely Canadian numbers would
be far off. "For a small country, we have a lot of artistic
impact," says Dr Chong. "We should take that seriously. We should look after the
health of our artists."
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