I recently returned from a trip to Taiwan to visit my lovely 90 year old grandmother.  While the trip, itself, was full of adventures and exploration, I was also there on another mission: to help promote musician wellness and injury prevention.  Having been a former piano teacher herself, my grandmother introduced me to the Chinese Culture University, where one of her former students is now a professor within the music department.  I was fortunate enough to be invited to spend the afternoon sharing my experiences and educating the future musicians of Taiwan on my passion in Performing Arts Medicine.  What was even more exciting, was their openness and curiosity to learn more about their bodies, how to play more effortlessly.

I was so grateful for the opportunity to be able to travel halfway around the world and to see first hand, once again, that the love of music transcends all cultures, languages and centuries.  This is why it's so important to protect the art and the people who interpret it and keep everyone happy and healthy.

Carpal Tunnel Syndrome (CTS) is one of the most commonly known wrist/hand injuries.  This ailment is often found in the sedentary desk job population, grocery checkout clerks, and other occupations associated with high quantities of repetitious movements -- including..... MUSICIANS.

As seen in the first image below, there are 3 major nerves that provide sensation to the hand.  They include the Median Nerve, Ulnar Nerve, and the Radial Nerve.  What is important to note, is that these nerves originate from the brain and are comprised of several cervical nerve roots in the neck before joining together to form the awesome super-highway nerves listed above.  CTS specifically describes the impingement of the Median Nerve at the level of the wrist.  

With CTS, the distribution of symptoms follows a specific pattern.  Most commonly, patients will complain of symptoms on the PALMAR aspect of their hand including the thumb, index, middle fingers as well as 1/2 of the ring finger (side closest to the middle finger).  It is very important to know this when trying to figure out which nerves may be affected, because the Ulnar and Radial Nerves will affect OTHER portions of your hand (to be discussed at a later date).

Common symptoms include:  

• NUMBNESS
  
• Tingling
• Decreased/Altered sensation
• Pain
• Weakness

CTS occurs when there is too much pressure within the carpal tunnel, a VERY small space where 9 tendons and the Median nerve pass through in order to go into the hand.

As you can see, there is not a whole lot of space for error.  So - when we subject our bodies to high stress/repetitive activities, inflammation and swelling can occur which can cause more pressure on the nerve.  

How would you like it if someone tried to squeeze their body into an already jam-packed elevator?  You would be irritated.  That's how your nerve is probably feeling.

You:  "Ok, Janice.  I've done my research, and I think I have CTS.  What do I do?"

First of all, it is not entirely advisable that you self-diagnose your problems, but HUGE Kudos for becoming an educated consumer and proactive in your health.  What IS advisable, is that you do your research as you have, AND consult a KNOWLEDGEABLE healthcare professional, such as a physical therapist or orthopedist.

Conservatively, there are a few things you can try to decrease your symptoms:

• Take FREQUENT rest breaks (this should be no surprise) - taking breaks will prevent tendonitis and decrease pressure through the carpal tunnel
• When typing/playing/performing, try to maintain a neutral wrist position
• Perform wrist stretches - these should be performed SYMPTOM FREE and PAIN FREE

You can access a few recommended wrist stretches HERE.


That's all for now.  Be happy and healthy!

As a physical therapist, one of the most common phrases that I hear when meeting new patients is "I don't work out as much as I want to."  Ok, fine.  Are you saying that because you mean it, or are you saying it because you have a health professional sitting in front of you and you feel that you need to say that to us?

You hear it all the time.  One of the top New Year's Resolution every year is to "lose weight" and "get in shape", and gyms all around the nation make a KILLING in the beginning of every year of people full of hope and promise of starting the new year off on the right foot.

As a performing artist, it is especially important that you try and have some sort of regular cardiovascular or strength training program set into place.  Like I mentioned in my last article, the large majority of musicians spend a large portion of their day either sitting at a desk job or practicing/rehearsing/performing. 

You tell me:  Same or different?

The Center of Disease Control currently recommends that a minimum of TWO types of physical activity is needed to improve overall health

• 2.5 hours of moderate-intensity aerobic activity in a week   +   muscle strengthening activities 2+ days/week

• Equivalent mix of moderate and vigorous-intensity aerobic activity + muscle strengthening activities 2+ days/week

You can read more about the CDC's recommendation HERE

Now, I am not recommending that everyone go out and jump into these high-intensity programs.  What I AM suggesting is that start at a level that you are comfortable with and gradually work your way up to these recommended durations, especially if you are currently leading a sedentary lifestyle.  This is something that needs to be built into your daily routine.  It will be a struggle at first, but soon enough it will become second nature, just like picking up and dinking around on your axe.

I'm hoping that in the near future, I can talk about specific exercise programs (ie. Insanity, Crossfit, CardioBarre, Piloxing - the newest rage here in LA), but honestly, there is so much stuff out there I would need a separate blog to cover it all.

Long story short, get out, move around, even if it is 'just' walking.  

Stop talking and start doing.  

It's been a long time coming.  After years of prodding and harassing from my friends, family and colleagues.... I mean - gentle encouragement... I've finally decided to embark on this journey of blogdom.

So, in honor of new beginnings and building things from the ground up, I present to you:  My mini piano.

It certainly has been a long road to get to this point.  From a clumsy 4 year-old finding her way around a piano, to being chosen to receive college scholarships for 2 instruments; one shoulder surgery, 5 months of lost playing-time, 6 years of undergraduate coursework and 3 years of graduate school later, I set forth on my mission to help the injured musicians on the world.  

I want to be THAT person.

What I have learned through the years as I transitioned from a music student --> performer --> teacher --> physical therapist, is that the human body is truly amazing.  It has the capability to do incredible things things, such as leap off tall buildings, lift burning cars off of trapped people.  

It can also do this:

The human body is also amazing, in a sense that it can withstand hours of repetitive motions and activities.  It does not discriminate whether you sit at a desk all day on the computer, or if you are a professional athlete practicing and training for hours/day.  If you do not respect your body and listen to what it's trying to tell you, it may eventually break down.  

I commonly work with patients who are elite or professional musicians.  The thing that always surprises me is how much they DON'T know about their bodies.  As musicians, we are always less concerned about WHAT we are doing than HOW it comes across to our audience.  But here's something else for you to think about:

When I was in college, this is what a typical week as a piano performance major consisted of

• Class = 25 hours
• Individual Practice: 3-4 hours/day
• Accompanying vocalists: 4 hours/week
• Orchestra practice: 4 hours/week
• Chamber music practice: 4 hours/week
• Private Lessons: 2 hours/week
• Homework/Chatting with my friends on my computer: 4 hours/day

That comes to about 42 hours of actual instrumental playing time.

BUT WAIT!!!

What about the time spent sitting in class or typing on the computer doing homework and chatting with my friends?

No wonder I was in pain.  I hurt just thinking about it.

And it is this point that I emphasize to the musicians who come in to see me at my clinic, and I want to emphasize this to you (whoever you are), now.

As a general rule of thumb, if you are a performing musician who spends many hours in a week playing, you should allocate AT LEAST 5 minutes of non-playing time for every 25 minutes of playing time.  During the 5 minutes, take time and move OUT of your playing position.  Stand up, move around, stretch.  Do yourself a favor and go find something else to do other than play or stare at your computer screen.  

Trust me.  Your body will thank you, and your audience will too.