Dealing with injury is a hard part of living a musical life

When an orchestra plays one generally marvels at the sound produced. But do you see how hard the players are working?

Musicians face substantial physical demands for their art and those demands can lead to injury.

That is when someone such as Pat Palmer comes in.

She runs P3 Physiotherapy, a clinic in Metcalfe, Ontario and she has become the go-to for injured violinists, trumpet players, oboists and pianists in the greater Ottawa area.

She knows that unless you are an injured musician, the general public doesn’t connect playing an instrument with a physical ailment.

Pat Palmer

Palmer knows because about 20 years ago, a member of the NAC Orchestra was referred to her.

“It blossomed from there. She referred three others and they referred three others and so on and so on. I have treated patients who play every instrument in the orchestra including conductors and their students.” Musicians make up between 20 and 25 per cent of her practice.

In 2007, Palmer was invited to talk to the high-calibre talent that is invited every summer to the NAC’s Young Artists Program.

“In the first few years I mainly lectured and in past five or six years I have actually been treating them as much as I can. There are a lot of them who are actually injured.

“I tell them about individual instruments and what I am looking for are the mechanics of how they are holding it, along with how flexible they are. I get them to assess themselves to see how flexible they are and how strong their shoulder girdles are and I ask ‘Is anyone injured right now?’ Sometimes one or two will sheepishly put their hands up.

But after speaking to the students for about an hour she said she will get another cohort of students coming to the front to ask privately about individual injuries.

At a certain point, the prevalance of pain was so great that the Young Artists Program officials asked Palmer to treat the afflicted.

“So that’s what I do now. It takes me 45 minutes to do an assessment and treatment and so I do that for 8 hours a day twice when the students are there. I’m probably treating 20 kids.”

This past summer she had a waiting list and couldn’t treat them all.

There are a number of factors that cause injury, Palmer said, including:

• Body type such as the size of hands, length of neck, lack of flexibility or too much flexibility;

• Pre-existing structural anomalies like scoliosis;

• Overuse from too much time spent practicing and playing;

• An absence of other activities such as yoga, pilates or working out.

Often it is a combination of factors causing an injury, she said. For example, even if the basic mechanics of the musician are excellent, if they are unfit, they will still get hurt. Or if they are too flexible, she said.

“Someone who is too flexible has to use muscles differently to stabilize their joints and they are at a disadvantage.”

Injuries affecting musicians also happen over time. Bad habits will catch up to anyone over a period of years

“Younger musicians do recover more quickly, but I definitely tell them you are only 20 for one year. You need to do cross-training just like any athlete. Musicians tend to just do music. The ones who are healthier longer, take care of themselves in other ways.”

Musicians also tend to over-work. Palmer suggests no more than an hour and a half a day, but she has found that some high achievers in the Young Srtists Program will practice six hours a day.

“No structure can tolerate that kind of use without breaking down.”

The students do it because they are competitive, driven and in love with music. Palmer says that getting through to them isn’t easy, until they are hurt.

“Then they have to put their instrument down and that can be devastating. They can’t do what they love to do, psychologically and physically.”

She has treated literally hundreds of musicians in her career. They hurt their arms, their thumbs, their jaws, their backs and their tendons. They get weird sounding injuries such as De Quervain’s tenosynovitis which is a painful condition that affects the tendons on the thumb side of the wrist. Or they might get thoracic outlet syndrome which is the compression of blood vessels or nerves between the collarbone and first rib. It causes pain in the neck and shoulders and numbness in the fingers.

Brass and woodwind players, for example, injure their shoulders, necks and jaws primarily because of the weight of the instruments. String players get arm, neck and shoulder injuries along with tendinitis.

Pianists suffer from carpal tunnel syndrome and tendinitis. Harpists occasionally get painful nodules in their fingers which can be devastating.

Vocalists will have injured jaws in addition to other dangers Palmer doesn’t treat such as nodules on the vocal chords. She has treated conductors for arm injuries.

She said that people in her clinic will recognize an injured musicians and will be surprised.

“I say to them have you ever seen Beethoven being performed. Look at the violins and how hard they are working, then they go ‘Yeah you are right’.”

To avoid injury, Palmer tells patients and the Young Artists that “generally you need to face your target as much as you can and that there are three planes of movement (in the body) from the front, from inside and with a rotation. The key is to minimize movement in all of those planes when playing. That will keep performer in a resting position as much as possible.”

Palmer was not aware of the prevalence of injuries when she treated her first musician in 1998. But, she now feels their pain, both physical and emotional.

“Being a musician, it is their life. I treat a few athletes but not many. They have same mindset they know that their career could be over because of injury. It is dealing with that part that I love. They are so motivated and talented. I am so fortunate to work with them.”

In the beginning, the musicians tried to hide the fact that they were being treated. Jobs could be at stake.

“My first few patients didn’t want to be seen by any other musician. I had to book them in an hour and a half apart so they wouldn’t see each other in the parking lot. Today they don’t care any more.

“It’s a nice environment now. It was very stressful when it first started happening for them and for me. I didn’t want to breach confidentiality so I had to be careful about that.”

Another, more mysterious , even sinister, condition, can afflict a player. It’s called Focal dystonia.

“I am getting pretty good at diagnosing Focal dystonia unfortunately. It is pretty common. I hate to be person to tell them but because it is so infrequently diagnosed and I see a lot of it, I am usually the person who has to break the news.”

It can occasionally be treated by Botox for example and other therapies such as medical marijuana can help, but it is often career ending.

Palmer said that Focal dystonia emerges from the basal ganglia, the part of the brain which mediates movement and movement disorders. It is also the part of the brain where Parkinson’s is situated.

Focal dystonia is a specific tremor that affects a muscle group or a single muscle and a very specific movement, Palmer said. Over time playing a flute the same way, every time, never allowing the brain to change “something intervenes,” she said. It is like a broken record.

She said that she has treated one bagpiper who had a Focal dystonia that affected the third finger on one hand and prevented him from performing trills.

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Peter Robb began his connection with the arts community in Ottawa in the mid-1980s when he was the administrator and public relations director of the Great Canadian Theatre Company. After a long career in journalism with the Ottawa Citizen where he served in a number of different posts he returned to the arts when he became the Citizen's arts editor.