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Performing Arts Safety Primer: Musicians And Actsafe Performing Arts Safety Table of contents Primers Introduction...................................................4 This book is one in a series of Performing Arts Safety MSI symptoms...................................................5 Primers that also includes: MSIs common to musicians.............................8 Prevention....................................................18 • The Performing Arts Safety Primer Treatment.......................................................27 • Dancers and MSI When to seek medical assistance................30 Additional information...................................31 Actsafe would like to thank Dr. Robert Cannon and Dan Robin- son, PhD. CCPE RK for their contributions towards this Primer. Feedback Request: We’re always looking to improve the qual- ity of our outreach and publications. If you have suggestions for improving this publication, we’d love to hear from you. Feel free to contact us by email at [email protected]. Note: The material in this publication is intended as educational information only. This publication does not replace the Occupa- tional Health & Safety Regulation administered by WorkSafeBC. Employers and workers should always refer to the Regulation for specific requirements that apply to their activities. ©2010 Actsafe. All rights reserved. Actsafe encourages the copying, reproduction and distribution of this document to promote health & safety in the workplace, provided Actsafe is acknowledged. However, no part of this publication may be copied, reproduced or distributed for profit or other commercial enterprise, nor may any part be incorporated into any other publications, without written permission from Actsafe. First printing, December 2010. Printed in Canada. 3 Introduction MSI symptoms A Musculoskeletal injury (MSI) is any injury or If you develop an MSI, you may experience disorder of the muscles, bones, joints, tendons, symptoms that interfere with your ability to ligaments, nerves, blood vessels, or related soft perform at the level you are accustomed to, tissues. This includes a strain, sprain, or inflam- including: mation that is caused or aggravated by activity. • pain Musicians (including vocalists) are prone to • weakness MSI that is caused or aggravated by practice, • numbness rehearsal, or performance. Playing a musical • tingling instrument may be second only to computer use • stiffness (reduced range of motion) in terms of population exposure to MSI. Some • loss of muscular control studies have shown that approximately half of professional musicians and music students Some musicians assume that their painful condi- experience significant MSI symptoms. tion is normal and find ways to mask the effects of the developing injury. This is partly due to a There are many things you can do to help pre- performance culture in which there is a long- vent and treat MSI. An MSI can be painful and standing philosophy that “the show must go on,” can interfere with both your professional and and partly due to a common concern among personal life, so it’s important to use prevention professional musicians of being labelled as a strategies. If you already have an MSI, there musician with an injury. are treatment options that will help you stop the injury from getting worse and speed up the heal- There is also a predominant medical perspective ing process. that MSI is neither life-threatening nor medically serious. However, an MSI can be artistically and professionally limiting, or even career-ending, 4 5 with devastating effects on your physical, emo- Level 4 tional, and financial well-being. If you experience Pain occurs as soon as you attempt to pain that may indicate MSI, take steps to deal participate in class, practice, rehearsal, or with the problem. performance, and is too severe to continue. Many aspects of daily life are affected. Below are the five levels of MSI signs and symp- toms in performers. If you are at Level 1 or 2, Level 5 modify your activities to prevent further progres- Pain is continuous during all activities of daily sion of symptoms. If you are at Level 3 or higher, life, and you are unable to participate in class, seek professional assistance. practice, rehearsal, or performance. Level 1 Pain occurs after class, practice, rehearsal, or performance, but you are able to perform normally. Level 2 Pain occurs during class, practice, rehearsal, or performance, but you are not restricted in performing. Level 3 Pain occurs during class, practice, rehearsal, or performance, and begins to affect some aspects of daily life. You must alter technique or reduce the duration of activity. 6 7 MSIs common to musicians Tendon and muscle disorders Tendon and muscle disorders that affect mu- Jaw and head Shoulder sicians include tendinitis and tenosynovitis, • Temporomandibular • Shoulder impingement joint (TMJ) dysfunction syndrome strains, and focal dystonia. Tendinitis and tenosynovitis Back and neck Tendons are rope-like structures made of strong, • Spondylolysis • Back and neck pain smooth fibres that do not stretch. During move- ment, tendons normally slide within a lubricated Hand and arm • Cubital tunnel tendon sheath. Excessive tension in the tendon syndrome or the friction of repeated movements can result • Thoracic outlet syndrome in irritation of the tendon (tendinitis) or sheath • Carpal tunnel (tenosynovitis). Awkward postures that stretch or syndrome • De Quervain’s bend tendons around joints increase tension and syndrome friction, contributing to the risk of MSIs such as • Arthritis tendinitis. • Lateral dystonia • Lateral epicondylitis (tennis elbow) Strains • Medial epicondylitis (golfer’s elbow) A strain is a stretch or tear of muscle fibres or connecting tissues such as tendons or fascia. Chronic strains result from prolonged overuse of muscles. Acute strains result from traumatic injuries to muscles. Excessive tension or impacts can eventually tear tendon fibres much like a rope can become frayed. Tendon strains usually result in the formation of scar tissue. Repeatedly strained 8 9 tendons can become thickened, bumpy, and Focal dystonia typically affects the: irregular. Prolonged irritation of the tendon • hands and fingers of string and keyboard sheath can cause the lining of the sheath to players thicken and constrict, making it difficult for the • feet of drummers tendon to slide in the sheath. • vocal chords of vocalists • embouchure of brass players Focal dystonia Focal dystonia is a muscle malfunction at a spe- You may experience referred symptoms in other cific location, which may result in: parts of your body when cramping or spasm oc- curs in the neck or back muscles. • cramping • involuntary flexing or straightening of a joint Tendon and muscle disorders in • a sense of fatigue specific body parts • loss of coordination Each musical instrument has particular physical Focal dystonia may or may not be painful, but and postural demands that place stresses on the it will interfere with your ability to play an instru- body. Knowing the parts of your body that are ment. more prone to injury may help you prevent MSI. Muscle cramping is not necessarily focal dysto- Hand, wrist and forearm injuries nia. Cramping or stiffness may occur as a result of the fatigue induced by a particularly long or Description of symptoms: Muscle strains oc- difficult practice session, rehearsal, or perform- cur in the small hand muscles that control lateral ance. However, focal dystonia is a condition finger movement and finger spread, as well as in which muscle dysfunction can occur in the those that flex the finger at the large metacarpal absence of fatigue. joint. Common with keyboards and guitar. 10 11 Description of symptoms: De Quervain’s Common in instruments that require complex syndrome is pain in the tendons at the base of postures with rotation of the forearm, bending the thumb and on the thumb side of the forearm. of the wrist, and independent finger movement, It becomes painful to move the thumb away from including keyboards, percussion, clarinet, oboe, the hand or engage in activities that require a harp, and trombone. firm grip or twisting motion. Description of symptoms: Rotator cuff tend- Common with clarinet, oboe, flute, keyboards initis is irritation of the shoulder tendons. Pain and percussion. usually occurs in the top or front part of the shoulder, or on the outer part of the upper arm. Description of symptoms: Irritation occurs in the muscles and tendons in the forearm that flex Common with instruments that require the arm and extend the wrist. to be in a raised position with the elbow pointing outward or forward, including violin, viola, cello, Common in instruments that require awkward double bass, and bassoon. postures, force, and fine coordinated movement of the hands and fingers, including strings, oboe, Back and neck French horn, and flute. Description of symptoms: Low back pain. Elbows and shoulders Common with musicians sitting in restricted pos- Description of symptoms: Epicondylitis is el- tures for long periods. bow soreness where the forearm muscles attach to the bone on the elbow’s outer edge (lateral Description of symptoms: Upper back and epicondylitis) or inner edge (medial epicondyli- neck pain. tis). It may also cause forearm or wrist pain. Common with instruments that require specific playing postures and force, particularly of the 12 13 head and upper arms, to support the instrument, sensory nerves. This tends to happen at specific including violin, viola, flute, harp, saxophone, locations: where the
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