Music and Medicine on Monday at the University of Iowa - Schedule of Events

protocol page initiated Feb 2024  Piper Wenzel BS, Henry Hoffman MD

60 second 'short' addressing percussionists' calluses

full video of interview and performance addressing prevention and treatment of injury :

Definitions

Repetitive Stress Injury / Repetitive Strain Injury / Occupational Overuse Syndrome / Occupational Cramp:    The number of alternative names for this group of injuries as per W Stone indicates a lack of understanding about them. He favors Occupational Overuse Syndrome encompassing conditions characterised by discomfort or peristent pain (in the arms)...caused or aggravated by work" (Stone 1983). As per HJ Fry (1986) - In 1887, Poore stated that the term pianist's cramp "might tend to make you believe that you had made a diagnosis when, in fact, you had only used a word" (see more information about another process associated with repetitive processes in musicians: musician's dystonia)

Muscle Fatigue:  A process wherein "muscle function diminishes with use to a point that it can no longer perform its expected function with the same level or intensity as when rested (exhaustion)". (Winspur 2003) This process is considered reversible with rest. Muscle fatique is thought to be related to chemical and physical changes with discomfort mediated through nerve endings in the muscle. 

Misuse (in the case of instrumental musician): 'incorrect technical handling of the instrument, practice, or repertoire" (Winspur 2003)

    may extend the 'misuse' concept to include a poor match between musician and instrument     from Winspur citing Markison: "What is not widely appreciated is that some musicians are just not physically suited for their chosen instrument—the harpist with short arms, the violinist with a long neck, and the child with small hands" Markison (1990) Further discussion about a long history of adapting the size and shape of musical instruments to the performer as an important option.

Overuse: 'too much use' (Winspur 2003) - 'stress applied is greater than the tissue can tolerate.. and it breaks down" (Pitner 1990)

Tendinopathy: (per Elsevier Point of Care 2021) a "clinical syndrome most commonly resulting from repetitive motion or overuse of a tendon, resulting in pain, swelling, and impairment of function; the process is inflammatory in the early stage but may progress to a degenerative process in the subacute and chronic phases"  Tendinopathy is an umbrella term that encompasses tenosynovits, tendinitis and tendinosis.

Carpal tunnel: a canal on the palmar/anterior side of the wrist, bordered anteriorly by the flexor retinaculum, "a thick band of connective tissue". Its posterior, lateral, and medial walls consist of carpal bones. The contents of the carpal tunnel include the median nerve and flexor tendons of the forearm (Drake et al. 2020).

Carpal tunnel syndrome: the most frequent nerve entrapment syndrome characterized "by compression of the median nerve at the wrist as it passes through a space-limited osteofibrous canal" (Padua et al. 2016)

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Trigger finger: disorder characterized by "catching or snapping" of one or more flexor tendons in the hand, may also present with pain and dysfunction (Drake et al. 2020)

• May be related to fibrosis (scarring) and "tightening of the flexor tendon sheath" at the metacarpophalangeal joint (MCP)

Background

Mallet percussion has a long history dating to the Neolithic Period, between 5,000 and 9,000 years ago (Moersch 2016 citing NY Times article 1954)

Vibraphones, xylophones, glockenspiels, and chimes have been part of the evolution of mallet instruments with reference to a more contemporary instrument termed by Moersch as the  Aluphone: "a keyboard composed of spun aluminum bowls" as a member of the mallet percussion family

Prevention of Injury

From Loria citing Beveridge et al. "drummers with higher levels of expertise demonstrated reduced levels of muscle co-contraction in the wrists and hands" compared to  "drummers with limited experience displayed greater muscle co-contraction in wrist flexor and extensor muscles to stabilize drumming strokes"

Three simple rules per Andy Harnsberger:

1. Stretch/warm-up slowly

2. Practice slowly

3. Ice my hands at the end of the day to take care of any swelling that has accumulated during the course of practice sessions

Harnsberger, A: Stretching for Pain-Free Performance - "First appeared in Percussive Notes. Reprinted by permission of the Percussive Arts Society, Inc. - www.pas.org."

Video:

References

Moersch, W: Marimba revolution Mallet instruments, repertoire, and technique in the twenty-first century Chapter 3 pp 43-54 in
The Cambridge Companion to Percussion DOI: https://doi.org/10.1017/CBO9781316145074.004 Publisher: Cambridge University Press Print publication year: 2016

“Stone-Age ‘Marimba’ Is Discovered in Vietnam,” New York Times (March 18, 1954), p. 3.

Osiak K, Elnazir P, Walocha JA, Pasternak A. Carpal tunnel syndrome: state-of-the-art review. Folia Morphol (Warsz). 2022;81(4):851-862. doi: 10.5603/FM.a2021.0121. Epub 2021 Nov 16. PMID: 34783004.

Loria T, Teich JE, Pranjić M, Tan M, Huang A, Thaut MH. The Impact of Limb Velocity Variability on Mallet Accuracy in Marimba Performance. J Mot Behav. 2022;54(6):694-705. doi: 10.1080/00222895.2022.2069080. Epub 2022 Apr 26. PMID: 35473577.

Shafer-Crane GA. Repetitive stress and strain injuries: preventive exercises for the musician. Phys Med Rehabil Clin N Am. 2006 Nov;17(4):827-42. doi: 10.1016/j.pmr.2006.07.005. PMID: 17097483.

Chan C, Ackermann B. Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians. Front Psychol. 2014 Jul 8;5:706. doi: 10.3389/fpsyg.2014.00706. PMID: 25071671; PMCID: PMC4086404.

Bongers PM, de Vet HC, Blatter BM. RSI: vóórkomen, ontstaan, therapie en preventie [Repetitive strain injury (RSI): occurrence, etiology, therapy and prevention]. Ned Tijdschr Geneeskd. 2002 Oct 19;146(42):1971-6. Dutch. PMID: 12420421.

Beveridge, S., Herff, S. A., Buck, B., Madden, G. B., &Jabusch, H. C. (2020). Expertise-related differences in wristmuscle co-contraction in drummers.Frontiers in Psychology,11,1–14.https://doi.org/10.3389/fpsyg.2020.01360

Langer P, Fadale P, Hulstyn M, Fleming B, Brady M. Survey of orthopaedic and sports medicine physicians regarding use of medrol dosepak for sports injuries. Arthroscopy. 2006; 22(12):1263-1269.

Winspur I. Controversies surrounding "misuse," "overuse," and "repetition" in musicians. Hand Clin. 2003 May;19(2):325-9, vii-viii. doi: 10.1016/s0749-0712(02)00124-5. PMID: 12852675.

cited by Winspur:

   Pitner M. Pathophysiology of overuse injuries in the hand and wrist. Hand Clin 1990;6:355–64.

   Markison RE. Treatment of musical hands: redesign of the interface. Hand Clin 1990;6:525–44

Stone WE. Repetitive strain injuries. Med J Aust 1983;2:616–8.

Parry, CBW: Prevention of musicians' hand problems. Hand Clinics Volume 19, Issue 2, May 2003 p 317-324  (C.B. Wynn Parry)

    Williams J: Guitar techniqeu in The musicians' hand (eds) I winspur, CB. Wynn Parry, Martine Dunitz, London 1998 pp 22-24

Harnsberger, A: Tools and Strategies to Optimize Performance and Sustain Longevity pp 46-50 in Percussive Notes (the official journal of the Percussive Arts Society home page  <Percussive Notes (pas.org) accessed 3-1-2024>)  Feb, 2023"First appeared in Percussive Notes. Reprinted by permission of the Percussive Arts Society, Inc. - www.pas.org."

Harnsberger, A: Don't Forget to Warm Up! Daily Marimab Warm-ups and Technical Exercises pp 44-47 in Percussive Notes (the official journal of the Percussive Arts Society home page  <Percussive Notes (pas.org) accessed 3-1-2024>)  Feb, 2023"First appeared in Percussive Notes. Reprinted by permission of the Percussive Arts Society, Inc. - www.pas.org."

Harnsberger, A: Stretching for Pain-Free Performance p 54-56 in Percussive Notes (the official journal of the Percussive Arts Society home page  <Percussive Notes (pas.org) accessed 3-1-2024>)  Feb, 2023 "First appeared in Percussive Notes. Reprinted by permission of the Percussive Arts Society, Inc. - www.pas.org."

Harnsberger, A: Optimize Your Performance Through Nutrition pp 28-29 in Percussive Notes (the official journal of the Percussive Arts Society home page  <Percussive Notes (pas.org) accessed 3-1-2024>)  Nov, 2011 "First appeared in Percussive Notes. Reprinted by permission of the Percussive Arts Society, Inc. - www.pas.org."

Images to be placed: "First appeared in Percussive Notes. Reprinted by permission of the Percussive Arts Society, Inc. - www.pas.org."

Donison C. Hand size vs the standard piano keyboard. Med Prob Perf Art 2000;15:111–4

Fry HJ. Overuse syndrome in musicians--100 years ago. An historical review. Med J Aust. 1986 Dec 1-15;145(11-12):620-5. doi: 10.5694/j.1326-5377.1986.tb139514.x. PMID: 3540544.

Hochberg FH, Leffert RD, Heller MD, Merriman L. Hand difficulties among musicians. JAMA 1983;249: 1869-1872

Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016 Nov;15(12):1273-1284. doi: 10.1016/S1474-4422(16)30231-9. Epub 2016 Oct 11. PMID: 27751557.

Drake RL, Vogl AW, Mitchell WMA. Gray’s anatomy for students (4th ed.) 2020.

Elsevier Point of Care Clinical Overview: Tendinopathy - Updated December 15, 2021. Copyright Elsevier BV. accessed ,July 7 2024 Tendinopathy - ClinicalKey (uiowa.edu)