THERAPEUTIC EXERCISES TO PRACTICE WHEN WORKING WITH MUSICIANS – PART 1

By Marianne Roos, M.Sc., Pht, Cand. PhD

1. LISTEN – more! Be empathetic

As we know, listening and understanding are important for all populations we may work with as clinicians. However, note that musicians are documented in the scientific literature all over the world describing being unheard and ununderstood by healthcare professionals, from surgeons to rehabilitation professionals (1,2). This lack of understanding dissuades them from consulting.

In fact, musicians are known to endure pain, avoiding seeking help, until they are no longer able to play (3). Such behavior contributes significantly to chronicity and further negative outcomes… so let’s offer them the ears that will encourage them to come to see us when they need it.

When (finally!) consulting, musicians want you to fully grasp the gravity of their problems in their lives and for their artistic functioning. What may seem to us to be a functioning finger may to them feel like it may as well be amputated, it’s useless! What to us seems like a swift recovery may seem to them like a tragedy (weeks of backward motion, missing opportunities, or setbacks with long-term impacts).

It is crucial never to minimize what they are going through or suggest that they are overreacting. Rather, try to help them put things in perspective, reinforcing messages such as, “The more thoroughly we work together now, the greater chance you’ll have of a quicker recovery. Then, you’ll be able to apply everything you’ve learned in the future, in order to prevent this problem from returning and even apply it to other areas of the body to prevent problems there.” They’ll find it reassuring to learn that they can regain control of the situation and even develop some expertise that they’ll be able to apply independently later on – this can help increase their low self-efficacy pertaining to health and well-being (3,4).

2. Observation of the musician playing their instrument

Observing the musician playing their instrument is crucial – not just if/when improvement is slow, but from the very beginning (video as needed).

I can’t emphasize this enough! I’ll admit that even though I had this in mind at the beginning of my clinical career, I often didn’t observe my musician clients as early as I could have. There are so many things to do and work on that we can easily fall into a treatment plan before completing this step.

Music Therapy Program – Memorial Rehabilitation Institute

However, for performance-related pain or injuries, and often for injuries that the musician may not consider to be playing-related, there is so much to be learned from this step – I quickly noticed that it’s not to be skipped. I have a Master’s degree in music performance and therefore have a fair knowledge of the instruments and the posture/technique required to play them – still, seeing individual musicians with their instruments can offer a wealth of information that we would not see otherwise. If you’re unfamiliar with the instruments, it’s even more crucial!

If having them play their instrument at the clinic is difficult or impossible (e.g. pianists), have them make short videos of themselves playing the passages that are problematic or cause pain, from 2 to 3 different angles.

WARNING

I’ve heard many young rehabilitation professionals jump straight to “posture” when discussing rehabilitation in musicians. Believe me, I know that when we look at musicians our rehab eyes can go crazy and we automatically identify all sorts of postural “problems.”

But don’t forget that no one has textbook posture, including top performing artists and athletes.

We need to avoid making assumptions about the role of posture in injury causation, 1) since such assumptions are not backed by evidence (on the contrary! (4)), 2) since postural adjustments applied liberally can have large impacts on musicians’ technique and start an unnecessary cascade of changes and repercussions, 3) since we need to respect the long tradition of music-making and hundreds of years of mastery that have produced today’s instrumental techniques, as well as the endless hours the musician has invested in playing the way they play – we have expertise that can help them, but we need to find a way for it to jive with their expertise.

Considering the above, the objective of observing the musician with and playing their instrument is to guide us in developing hypotheses of the problems alongside their injuries, such as a lack of endurance, strength or activation of certain muscle groups, or peripheral movements that are not well-supported by the trunk or large joints. Further testing is required to confirm the hypotheses before developing a treatment plan.

There’s so much more to say! Be sure to join us for the next blog on adapting your practice to musicians.

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References

1. Rickert DL, Barrett MS, Ackermann BJ. Injury and the orchestral environment: part III. the role of psychosocial factors in the experience of musicians undertaking rehabilitation. Medical problems of performing artists. 2014 Sep;29(3):125–35.
2. Brandfonbrener AG. Special issues in the medical assessment of musicians. Physical medicine and rehabilitation clinics of North America. 2006 Nov;17(4):747.
3. Rickert DL, Barrett MS, Ackermann BJ. Injury and the orchestral environment: part II. Organisational culture, behavioural norms, and attitudes to injury. Medical problems of performing artists. 2014 Jun;29(2):94–101.
4. Clark T, Lisboa T. Training for sustained performance: moving toward long-term musician development. Medical problems of performing artists. 2013 Sep;28(3):159–68.
5. Lewis JS, Green A, Wright C. Subacromial impingement syndrome: the role of posture and muscle imbalance. Journal of shoulder and elbow surgery. 2005 Jul;14(4):385–92.