Common Pain Syndromes
(with Anatomy!)
Current Pain or Injury, by Anatomical Site and Instrument Type
Head, Face, Lips
Neck
Upper limb and neck, left
Upper limb and neck, right
Trunk
Brass (n=58) Woodwind (n=67) Lower Stings (n=68) Upper Strings (n=169) Percussion (n=12)
8.6
4.5
2.9
1.2
17.2
9
16.2
12.4
16.7
15.5
6
11.8
18.9
8.3
13.8
29.9
25
21.3
25
32.8
17.9
30.9
23.1
16.7
Total (n=377)
3.2
13.5
14.6
22.3
24.9
Ackermann B, Driscoll T, Kenny D. Musculoskeletal Pain and Injury in
Professional Orchestral Musicians in Australia. Med Probl Perform Art
2012;27:181-187
Identification and Nominated Importance of Perceived Causative
Factors for Pain or Injury
Factor
Excess muscle tension
Muscle fatigue
Insufficient rest
Long practice sessions
Sudden increase in playing
Repertoire scheduling
Poor posture
Stress
Poor injury management
Performance anxiety
Lack of fitness
Instrument set-up
Technical flaws
Conductor approach
Lack of flexibility
Insuffieient warm-up
Touring
Identified (%)
Importance (%)
Had effect on pain
Improtant factor
82.4
76.8
80.5
82
75.5
71.7
77.9
69.6
62.8
62
67
58.7
57.5
49.3
65.7
66.7
37.2
73.5
70.8
70.3
66.9
65.6
63.8
63.3
58.5
47.9
47.6
45.8
44.7
38
37.7
35.4
31.6
23.6
Ackermann B, Driscoll T, Kenny D. Musculoskeletal Pain and Injury in
Professional Orchestral Musicians in Australia. Med Probl Perform Art
2012;27:181-187
Neck
• Thoracic Outlet Syndrome
– Compression or stretching of the neurovascular
structures of the neck leading into the arm
• Cause pain, tingling, numbness, heavy sensation, cold
to the touch, or cold sensation
• Can affect any part of the lateral neck or arm
Comparison of Muscle Activity While Playing the Violin
Muscle Activity
Upper Trapezius, Right
Upper Trapezius, Left
Cervical Extensors, Right
Cervical Extensors, Left
Sternocleidomastoid, Right
Sternocleidomastoid, Left
Pain Group (n=9)
9.81
24.26
19.29
21.53
15.68
10.38
Control Group (n=9)
7.67
14.52
11.98
16.67
9.11
4.15
p
0.350
0.001
0.001
0.030
0.016
0.000
Participants who reported neck pain after playing were put into
the pain group
Park K, Kwon O, Ha S, Kim S, Choi H, Weon J. Comparison of
Electromyographic Activity and Range of Neck Motion in Violin
Students with and without Neck Pain During Playing. Med Probl of
Perform Art. 2012;17:188-192
Shoulder
• Impingement Syndrome
– Compression of the structures in the subacromial
space
• Biceps tendon
• Supraspinatus tendon
• Subacromial Bursae
– Compression of this space is significantly
increased when the arm is elevated
Elbow, Wrist, Hand & Fingers
• Medial Epicondylitis
– Aggravation of the wrist / finger flexors
• Lateral Epicondylitis
– Aggravation of the wrist / finger extensors
• Carpel Tunnel Syndrome
– Impingement of medial nerve in the wrist
• Finger Pathologies
Flexors of the Wrist, Hand, and Fingers
Palmar wrist, hand, fingers
the elbow
Medial epicondyle of
Flexors of the Wrist, Hand, and Fingers
• When the wrist is flexed, there is a:
– Decrease in finger flexor muscle force
– Decrease in precision and dexterity
– Due to a phenomenon called active insufficiency
of the flexors and passive insufficiency of the
antagonists (extensor muscles)
Grandjean E: Manual de Ergonomia: Adaptando o Trabalho ao Homem.
Proto Alegre: Artes Medicas; 1998.
Extensors of the Wrist, Hand, and Fingers
Dorsal wrist, hand, fingers
the elbow
Lateral epicondyle of
Carpel Tunnel Syndrome
Carpel Tunnel Syndrome
Finger Pathologies
Low Back Pain
• Almost always related to postural
asymmetries
© Postural Restoration Institute
Brachial Chain (BC):
Anterior-Lateral Intercostals, Deltoid-Pectoral
Muscle, Sibson’s Fascia, Triangularis Sterni,
Sternocleidomastoid, Scaleni, Diaphragm
Anterior Interior Chain (AIC):
Diaphragm, Iliacus, Psoas, TFL, Vastus
Lateralis, Biceps Femoris
The Diaphragm is the overlap between the
two chains
© Postural Restoration Institute
Physical Preparation
Instrument and Environment Analysis
• Making sure the instrument is placed in an
ergonomically correct position
– Support stands, straps, athletic taping, orthotic
device
• Correct seating
• Lighting
• Placement of music stand
Recommendations
Recommendations using everything
we now know
• Proper outside-of-music activity is important for
increased performance ability and injury reduction
• Reduce stress
– Let pain be your guide
• Appropriate warm-up is essential
– Focusing on the problem areas discussed in this lecture
Warm-up
• Finger flexion and extension
• Arm and trunk range of motion
• Stretching
– From fingers to low back, every muscle group has
the potential to cause a pain syndrome
• Simple music
• More complex music
When you Feel Pain…
• “PRICED”
–P
–R
–I
–C
–E
–D
Protect
Rest
Ice
Compression
Elevation
Diagnosis
Performing Arts Medicine
at Appalachian State
Performing Arts Medicine
• At Appalachian State University:
– College of Health Sciences
– Department of Theatre & Dance
– Athletics Department
– Hayes School of Music
• Staff with performing arts medicine education
– Program implementation
– Research
PerformingArtsMedicine.appstate.edu
Questions?