Musicians and RSI
Musicians and RSI – An interview with therapist Susan Chapelle
For most of my 30-year career as a musician, I’ve been blissfully free of aches and pains. I could pound away at the keyboard for hours on end and then run out to play a couple of sets of tennis – no problem. I was invincible.
But about five years ago I began noticing sharp pains in my forearm after I’d played tennis. After I stopped that year they went away. The next year, the pains were back. I dismissed it as “stiff muscles”. I decided to just go ahead playing as much tennis as possible in order to build up more strength. Macho athletic slogans bounced through my head: “No pain, no gain! Play through it! Be a man!”
Those sharp pains got worse. Now there was tingling and numbness in my fingers. I stopped playing tennis altogether, and to my alarm the pain didn’t go away – not for the rest of that year or the next year. It didn’t go away in spite of regular treatments to physiotherapists and alternative therapists of virtually every description. I’d been prodded, adjusted, injected, scolded, blessed and jabbed by just about everyone this side of Saskatoon. Turning a key in a car door lock still sent bolt of lightning pains down my arm. Even holding a tea cup made me cautious, knowing that I could be struck at a moment’s notice by the cruel and vengeful god of tendonitis thunder.
Thankfully, although it ended my tennis ambitions, it didn’t seem to interfere with my keyboard or guitar playing. I cut back on my violin playing because how could violin playing possibly do anyone’s arm any good? The only thing that seemed to make the forearm pains manageable was the hot-and-cold contrast baths that one therapist recommended. I decided that this tendonitis that I had was chronic and thought that the best I could do was to learn to live with it.
Then the bursitis in my shoulder started late last year and I gradually lost range of motion in my shoulder. I stopped playing violin and guitar. I stayed away from the computer for a week, but still I lost about a 1/4 inch of range with each passing day. Lifting my arm over my head was a painful ordeal. I again frantically raced around to therapists. One told me that soon I wouldn’t be able to lift my right arm at all. He wasn’t terribly encouraging. “You waited too long”, he said ominously before every treatment session, in his best funeral director’s voice.
I continued therapy but there was no improvement. Along with my range of motion, I was also losing my sense of humour. I was even contemplating turning down a good movie-of-the-week that came with a nice music budget. Could I be sued if I started the score and wasn’t able to finish it?
A bass player friend recommended a deep tissue massage therapist, Susan Chapelle, who apparently specialized in treating RSI (repetitive strain injuries) in musicians. Desperate and feeling that my career was on the line, I contacted her and immediately began treatment.
Susan was an iconoclastic, no-nonsense, down-to-earth sort who demonstrated a deep knowledge of anatomy and approached repairing my damaged muscles as a skilled car mechanic, twisting and pulling my tendons like she was installing a new cam shaft.
At Susan’s massage table there was no incense, and no cheesily synthesized “Pachabel’s Canon” wafting up from a ghetto-blaster. No airy-fairy new age vibrations at all in this place. She treated me three times a week and insisted that I put in the hours stretching and strengthening on my own time to make sure that the gains were not lost.
Within two months my tendinitis and bursitis had improved by about 90%. I was playing violin again and after five years, even played a little girly-man tennis.
During those long and sometimes painful hours on the massage table I talked to Susan about musicians and RSI and decided to conduct an interview with her. The questions were sent to her via E-mail.
Q: What are the most common RSI problems that you come across with musicians?
The most common RSI problems in musicians seem to stem from muscle imbalances related to the particular instrument that is being played. These imbalances can lead to what is commonly known as “tennis elbow” or tendinitis of the elbow. Other problem areas that I see alot of are in the shoulder girdle, low back (sciatica) and carpal-tunnel regions.
Q: How treatable is tendinitis and bursitis?
Tendinitis and bursitis are very treatable. Assessment is a huge factor in “fixing” pain in the soft tissue. A therapist or doctor should be looking at the person as a whole. What are the contributing factors in this persons life that has led to a RSI disorder? Lifestyle and diet, bad ergonomic studio set-up, how the instrument(s) are being played (i.e. posture and muscle use) – all must be addressed in order to permanently change a painful situation.
Q: What are some of the most important things composers (as people who sit in front of a computer all day) can do to prevent RSI?
Take care of your health. Take breaks and stretch. Often, once an idea is at hand, a musician / composer will sit in the studio for hours on end with no break. Movement and stretching the muscles to maintain their length is one of the best things to prevent injury. Every 1/2 hour get up and do some opposite movements for the hands and lower back.
Q: What causes tendinitis? Is it usually one thing or a variety of factors?
Tendinitis is an inflammatory condition of the tendons that occurs as a result of repeated microtrauma. It is characterized by painful scarring within the tendon and pain with use of the affected muscles. It is usually a variety of factors that contribute to the scarring, but with musicians it can be building over many years of using a muscle in a shortened, contracted position. Many musicians are involved in other sports and yet have trouble thinking of their instrument or work environment as physical work. Injuries often occur not as a direct result of playing, but as a secondary injury due to hockey or tennis because the muscles are in a shortened position from the instrument posture. Stretching, icing after long playing sessions, as well as strengthening weakened structures are essential to prevention of RSI.
Q: What are the early warning signs that signal the onset of tendinitis or bursitis?
Pain on activity in the affected muscle. Not being able to lift your coffee cup in the morning is a common one.
Q: I understand that the cause of pain someone might be feeling in the arms or shoulders might be originating somewhere else. Can you talk a little about “referred pain”?
When muscles are used at a shortened length over an extended period of time, the brain uses protective mechanisms commonly referred to as “trigger points”. This mechanism is used by the body to protect shortened muscles from being injured. The definition of a trigger point as defined by Janet Travel, M.D. (Travel, Simians 1992) is “a hyper-irritable spot, usually within a taught band of skeletal muscle or its fascia, that is painful on compression”. Trigger points can give rise to characteristic referred pain, tenderness, and autonomic phenomena (organ or internal pain). They can be worked out of muscle with deep tissue massage. So, often one can feel pain in one part of the body, and the offending tissue is actually in a different location. Fascia (the wrapping of the muscles) can also cause pulling or tension in different locations when it is adhered to other structures.
Q: What’s happening when someone has tingling or numbness in their fingers?
Once someone is experiencing numbness or tingling, it is usually an indicator of tight muscles impinging on the blood or nerve supply to the extremities. A common occurrence in musicians is waking up with numb or tingling fingers from sleeping with their arms over top their heads. Tight muscles in the neck area impinge on nerves and on the blood supply to the arm. This can be stopped by reducing the stiffness in the neck via massage, or stretching.
Q: How are musicians when it comes to seeking treatment for RSI?
Musicians are terrible at seeking treatment! Most often the playing has to become extremely inhibited by physical pain. I find many musicians are in denial about their pain because they fear losing the ability to play. They leave it far too long to get treated, and something that could have been resolved ends up being a chronic problem.
Q: Are there any particular instruments that are bad when it comes to RSI?
Most instruments have unnatural postures, and as a result the musician has muscle imbalances. I would have to say violin, keyboard players, bass and guitar players are the ones I see most in my clinic. Most musicians also work in the studio, and have their racks set up incorrectly for posture, as well as an ergonomically incorrect set-up of their computer or keyboard.
Q: At the onset of my tendinitis years ago, I went to an MD who immediately shot cortisone into my elbow. How effective is cortisone treatment?
Cortisone treatment is or should be the last resort in a line of treatment that usually starts with anti-inflammatories. However, there is no long-term research to prove that cortisone therapy is effective in the treatment of RSI. It is a very strong anti-inflammatory and it is believed that local injection will reduce the inflammation and resolve the problem. The problem with cortisone is it actually breaks down the tissue causing an increased build-up of scarring. This will, over the long term, cause an increase in inflammation and makes the original RSI problem more difficult to treat. I am currently seeking funding for a research project that will compare massage therapy to conventional or allopathic therapy in the treatment of RSI in the long term.
Q: How does your type of massage differ from the more typical relaxation-type massage?
My massage is very treatment-oriented. I like to see my patients back at their instruments as soon as possible. This involves muscle balancing, education and a ton of home care. Most people are shocked when getting treated by me. They come with expectations of relaxation massage, and have no idea how much work I expect them to put in to resolve the problem.
Q: What should someone look for in a therapist? How trained do you have to be? How trained are you?
If someone is seeking massage therapy, they should look for a registered massage therapist. This means the therapist is regulated under the Regulated Health Professions Act and Massage Therapy Act, has insurance and is properly trained, having taken provincial and college exams. I completed 2 years of training at Sutherland Chan and have done extensive post-graduate studies in many areas. I feel that a good therapist should have extensive knowledge of anatomy, and an exceptional ability to link movement with structures.
Q: I know a lot of musicians are in a state of RSI denial. Can you talk a little about the accompanying psychological problems that happen with RSI?
RSI is a difficult diagnosis for a musician to hear. Often they know others who have been told they should stop playing their instrument. A difficult thing if you earn your bread and butter by playing! Musicians are reluctant to try natural or “alternative” therapies, and end up back and forth to many clinics that don’t get results.
Q: In your experience, what’s the most effective treatment for RSI?
The most effective treatment is learning about your body, and being educated on how to care for it, because most musicians live a fairly unhealthy lifestyle. They also tend to not connect their bodies to their instruments, but they are completely connected. Musicians should think of themselves as athletes.
This article orginally appeared in “Spotting Notes” which is the newsletter for the Guild of Canadian film & television composers.