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Repetitive Stress Syndromes: Defining, Recognizing, Preventing, and Addressing –Brian Toy, Douglas T. Owens, and Thomas Parchman
BY BRIAN TOY, DOUGLAS T. OWENS, AND THOMAS PARCHMAN
Key words/phrases: repetitive stress syndrome; overuse injury; musculoskeletal injury; neurologic condition; musicians’ health
ABSTRACT Musicians of all ages and skill levels are at risk of developing a range of overuse musculoskeletal and neurologic injuries that result from playing a musical instrument. Otherwise referred to as Repetitive Stress Syndromes (RSSs), these conditions occur due to a variety of reasons, some of which can be avoided through the implementation of simple preventative measures. However, since all who play a musical instrument are at risk of developing one or more of these conditions, musicians should maintain a basic understanding of those RSSs that result from practicing and performing. Furthermore, so that an emerging overuse condition does not ultimately impede on an individual’s ability to play, musicians should know the common signs and symptoms related to a developing RSS. Finally, musicians should be ready to seek medical attention from a qualified health care provider when an overuse injury occurs. Repetitive Stress Syndromes: Defining, Recognizing, Preventing and Addressing
INTRODUCTION A considerable amount of scholarly literature is published on the types of overuse musculoskeletal and neurologic injuries that result from playing musical instruments. Indeed, it is reported that up to 60% of musicians can expect to suffer some type of overuse injury trauma from playing (Abréu-Ramos and Micheo 2007; Guptill and Zara, 2010). Such medical conditions occur in musicians across every family of instruments, and players of all ages and skills are affected. These disorders affect a variety of body parts including the back, neck, shoulders, arms, elbows, forearms, wrists, hands, fingers, thumbs, legs and feet (Shoup, 1995). Abréu-Ramos and Micheo (2007) and White (2017) also report that medical conditions that affect the muscles of the face and mouth, including those that make the lips, jaw, and tongue move, occur because of playing a musical instrument. Otherwise known as chronic injuries (Dawson, 2006), overuse syndromes (Fry, 1988), and cumulative trauma disorders (Ostwald et al., 1994), these Repetitive Stress Syndromes (RSSs) are some of the most common injuries suffered by those who play musical instruments (Abréu-Ramos and Micheo, 2007; Fry, 1988). Thus, the purpose of this article is to review the most common types of RSSs that occur to musicians. Furthermore, risk factors associated with these conditions, the strategies used to prevent such injuries from occurring, the signs and symptoms commonly associated with these conditions, and the course of action a musician should take when experiencing a RSS are also discussed.
A state licensed and nationally certified athletic trainer, Dr. Brian J. Toy is an Associate Professor in the Department of Exercise, Health and Sport Sciences at the University of Southern Maine. He received the B.S. degree from SUNY Cortland, the M.S. degree from Marshall University, and the PhD from the University of Toledo. Dr. Toy has served USM as the Director of Athletic Training Education, Department Chairperson, Associate Dean, and Interim Dean of USM College of Nursing and Health Professions, and Lewiston Auburn College. He is the author of Primary Care for Sports and Fitness: A Lifespan Approach.
Repetitive Stress Syndromes ..., Toy, Owens, and Parchman, cont.
REPETITIVE STRESS SYNDROMES COMMONLY EXPERIENCED BY MUSICIANS In general, a RSS results from the motions associated with playing a musical instrument for an extended period (Hochberg and Newmark, 1987). When such motions chronically stress human tissue, commonly soft tissue, beyond the tissue’s physical limits, the development of a RSS is a typical outcome (Ostwald et al., 1994). Common RSSs caused by this type of overuse include fibromyalgia, a condition classified by generalized joint pain (Knishkowy and Lederman, 1986); muscle tears, also referred to as muscle strains (Shoup, 1995); impingement syndromes, where soft tissues such as a muscle’s tendon or a nerve become entrapped within an anatomical confined space (Toy and Healy, 2009); and general muscletendon overuse (Knishkowy and Lederman, 1986). Furthermore, it is reported that certain musicians are at higher risk for developing specific types of RSSs. For example, Hochberg and Newmark (1987) found that pianists tend to develop muscle-tendon overuse conditions of the fingers and wrist due to the constant movement of these body parts during play whereas AbréuRamos and Micheo (2007) report that shoulder impingement syndrome, where a tendon of a shoulder muscle becomes entrapped, typically occurs to symphony orchestra musicians, such as violinists. This is because these musicians are required keep the shoulders in an elevated position for extended periods during play. Other conditions, such as fibromyalgia, seem to affect a variety of instrumentalists, making many musicians vulnerable to developing this and other like conditions (Lederman, 1995; Lederman and Calabrease, 1986).
Disorders that result in an inflammatory response, otherwise known as “itis” conditions, are also classified as RSSs. These include inflammation of a tendon, also known as tendinitis (Lederman, 1995); tenosynovitis, an inflammation to the sheath that surrounds a tendon (Hochberg and Newmark, 1987); and epicondylitis, an inflammation which occurs on the inside and/or outside of the elbow resulting from overusing the muscles which move the wrist and fingers (Knishkowy and Lederman, 1986). Though all musicians, and most body parts, are at risk of developing an itis condition, the elbow, forearm, wrist and hand of the percussionist are particularly vulnerable due to the forces placed on these structures when playing percussion instruments whereas shoulder tendinitis commonly occurs in string players and wind instrumentalists (Chong et al., 1989).
Repetitive stress caused by playing a musical instrument can also adversely affect the many peripheral nerves located throughout the body. Classified as “peripheral” since they reside outside of the brain and spinal cord, when activated, these nerves cause skeletal muscles to contract and work in harmony to produce coordinated body movements. Peripheral nerves also provide the body with the ability to respond to sensory stimuli such as touch, changes in body position, and pain. When under undue stress, a peripheral nerve can be injured at any point along its path as it travels from the spinal cord to its end in either a skeletal muscle or the skin. When an injury occurs to a nerve going to a muscle, the function of that muscle is affected; when an injury occurs to a nerve going to the skin, a sensory deficit, such as numbness or tingling in an extremity, is the outcome. In certain instances, a singular nerve goes to both a muscle and the skin. Thus, damage to such a nerve can cause both muscle, and sensory deficits. Certainly, pain can be
Dr. Douglas T. Owens is the F. Ludwig Diehn Endowed Chair of Instrumental Music Education, Graduate Program Director, and former Chairperson of the F. Ludwig Diehn School of Music at Old Dominion University in Norfolk, VA. He earned the B.M.E and M.M. degrees from the University of Colorado Boulder, and the Doctor of Arts degree from the University of Northern Colorado. Dr. Owens has published research in Medical Problems of Performing Artists, the National Band Association Journal and The Instrumentalist. He directs the ODU Jazz Orchestra and serves as a concert band and jazz ensemble guest conductor and clinician.
