History of Performance-Related

Hand Injuries

Many professional musicians throughout centuries have been effected by hand injuries, such as Robert Schumann, Clara Schumann, Glenn Gould, Leon Fleisher and others. Prior to the end this century performers rarely admitted or discussed with other performers about their injuries. Yet, we know that there were many musicians who did suffer from different kinds of injuries. Robert Schumann is one of the most well-known examples.

Even though musicians are aware of the effects of these injuries that can cost losing their careers, most of them think that they are protected from them. The reason for the absence of any fear, most of the time, is due to the lack of knowledge and understanding of problems that can cause these injuries and also the way to overcome them. Performance related injuries increased in the nineteenth-century because of the instrumental changes! Pianos were made with heavier action and stronger frame, woodwind instruments were made from heavier woods, and compositions became more difficult and demanding. While these changes in the instruments occurred the teaching techniques however did not change.

The finger-only technique used with the eighteenth century pianos was applied to these new pianos that had heavier action which made it for the hands more difficult to perform.

Through the years there has been many different views on the reasons of performance related injuries. Rose V. Johnson in his article states that "many doctors believe that musicians are prone to the injuries when their overall health and physical well being is compromised." Many other professionals blame injuries on incorrect postures and positioning. One theory states that" some musicians suffer the end result of lifelong contact with a chosen instrument that carries some health risks because of weight, surface chemistry or functional demands." Some psychologists believe that injuries are results of psychosomatic transferal of angry feelings to the parts of the body that are associated with performance.

"Performing Arts Medicine" emerged in 1982 due to the change in the perception of performance related injuries by musicians. Up until today many musicians and doctors have difficulty in understanding the exact reasons of these injuries and how to treat them.

According to Rose V. Johnson's article performance injuries are often called "overuse" injuries. The most common type of performance related injuries have several terms, such as tendinitis or tenosynovitis, rheumatism, repetitive-strain injury (RSI), or overuse syndrome. Another type of injury is neural impingement or nerve-entrapment. Carpal-tunnel syndrome, nerve neuropathy, and thoracic-outlet syndrum fall into this category of injuries. The final class of injuries is the most difficult to treat which is focal dystonias. This injury leads to loss of muscular control sometimes with pain and sometimes without pain. Other names for this injury are musician's cramp or piper's palsy.

According to Ralph Mancherster's study, 5-10% of music performance students were affected by these injuries. Women were effected twice as often as men were and the average age of these musicians ranged from 17 to 39 years old. The greatest increase in injuries occurred in February and September when semesters begin and keyboard with string players were affected the most. Wind, and brass players were followed by percussionists who had the lowest numbers of injuries.

The term "Music Medicine " was created 1982. The new journal "Medical Problems of Performing Artists" was published in 1986. In this journal Gary Graffman, professional pianist, had an article about his own hand problems prior to the year of 1981. During these years the public was becoming more aware about these injuries through the difficulties of famous pianists, one of them being Leon Fleisher. He was diagnosed with torsion dystonia which was difficult to treat. The International Journal of Arts Medicine began publication in 1991 and there are annual meetings in Aspen, Colorado of the Performing Arts Medical Association (PAMA). As we can see the public awareness and the action taken towards these injuries began in the last twenty years and are still developing. Medicine itself is still puzzled about the causes of these injuries as it was hundreds of years ago. But that hasn't stop either the doctors or the musicians from trying to understand and fight these injuries to the best of their abilities.

What happens then to the musicians who deal with these injuries? The first thing they don't want to do is to take a "rest" from playing their instrument. Resting is a threat to them because of their concerts or commitments they have with their own treatment, which involves not a complete rest but a "fake" one. For example they take more breakes during their practicing, yet they still aggravate their hands' nerves and get in return more pain!!!

Those of you who are musicians, music students, and teachers know that it is hard to break a habit that has been so strongly developed through practicing everyday. So, I know that is difficult to tell a musician and/or a music student working on his/her degree to quit practicing for a month!!!!! It is the last thing one would ever want to hear! For a musician it feels like you are telling them to stop breathing!!! But in some cases it saves so much more time in the long run that many fail to understand while they are in shock because of their situation. Through my personal experience, I know exactly how hard it is to stop practicing or even just playing for your own pleasure, but in most cases it is a necessary state of life!!! Approaching your pain and trying to find medical care for it is one of the first steps one should follow.

Many musicians try to ignore their pain by using their own methods that makes their case even more difficult in the long run. Most of the time psychological reasons make musicians hide their pain and injury due to the fear of losing prestige in the music world or even their careers in some cases. Whatever the reason, running away from any problem has proven to be, for centuries, not a successful solution for anyone! So, I would encourage those of you with performance-related injuries, or any other kind for that matter, to embrace their fears and find a treatment! In the following link you will find a quick checklist for selecting a medical specialist; that might be a good starting point! www.sugarriver.net/lunnflutes/ho6.htm

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