Music can touch people in many profound ways. This goes for musicians too: there are unexpected health risks involved in being a musician, from skin allergies and tendonitis, to carpal tunnel syndrome and fiddler's neck.
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The playing of most musical instruments is not a natural activity for the human body. The demands on posture, muscle tension, dexterity, and endurance, can be immense. And, if the body doesn't stand up to the strain, it could mean a few months of musical inactivity, or even the end of a musical career.
Repetitive motion injuries
Most of the possible injuries faced by musicians fall into the repetitive motion category. Clinching the neck of a guitar or violin for hours on end, while performing precise finger movements can easily cause tendonitis - inflammation of the tendons in the hand or forearm. Symptoms of tendonitis include pain and numbness.
Trying to play through the pain is likely to aggravate the inflammation and could lead to small tears developing in the tendon. If your tendons are not given sufficient time to recover, more severe symptoms could follow, and you may well do permanent damage.
Carpal tunnel syndrome Musicians are also at high risk of developing carpal tunnel syndrome, a condition often associated with excessive use of a computer keyboard. This condition is caused by irritation of the median nerve in the wrist, also as a result of repetitive motion.
The initial symptoms of carpal tunnel syndrome include a numbness and tingling sensation in the thumb, index, and middle fingers. If the affected hand is not sufficiently rested, symptoms can progress to decreased grip strength, cramping, and occasional stabbing pains.
Cubital tunnel syndrome is a similar condition, resulting from the irritation of the ulnar nerve in the elbow. This condition is associated with pain in the elbow region and a tingling sensation in the pinkie and ring finger.
Other conditions include: De Quirvain's tenosynovitis, associated with pain on the thumb-side of the forearm, myofacial pain, thoracic outlet syndrome, and trigger finger/thumb, a condition which sometimes causes a finger to lock in a certain position.
Treatment for these syndromes
The first line of treatment for most of these conditions is to rest the affected hand or arm. Putting your instrument away for a few days or weeks may prevent more serious damage from occurring. Changes to posture and playing technique could also make a crucial difference.
If symptoms persist, or are particularly severe, you should not hesitate to see a doctor. Non-steroidal anti-inflammatory drugs and corticosteroids are often prescribed, and there is a strong suggestion that vitamin B6 may also be of help.
Other treatments include applying ice to the affected area and wearing a splint to keep the finger or wrist in position. In some cases surgical treatment may be required.
The following should help to avoid the musculoskeletal problems outlined above:
Warm up for at least ten minutes before starting a practice or playing session. A bit of finger stretching is highly recommended.
Take regular breaks. A five-minute break every half an hour should do. Get up, stretch a bit, and make sure you have proper circulation in your hands.
If it hurts, stop playing. Trying to play through the pain will only aggravate the problem.
Make sure that your posture is as upright and as comfortable as possible. Try to avoid sitting with a bent back.
Try to keep the tension and pressure in your hands and arms as low as possible. Musicians often exert more pressure on the strings than what is needed.
Musicians and skin problems
A review article published online in the journal BMC Dermatology in April 2004 concluded that, "Skin conditions may be a significant problem not only in professional instrumentalists, but also in musicians of all ages and ability. Although not life-threatening, they may lead to impaired performance and occupational hazard."
Playing an instrument can aggravate existing skin conditions like atopic eczema and psoriasis. Furthermore, the prolonged, intense contact between skin and instrument can spark a number of skin conditions, of which allergic contact dermatitis is the most common.
The most notable allergic sensitisers are colophony, nickel, and certain exotic woods.
Colophony (rosin), often used by cellists or violinists to wax their strings, has been known to cause dermatitis - scaling, flaking, and irritation of the affected skin - in the area where the skin is in contact with the instrument.
An estimated eight percent of women have sensitivity to nickel, which is often used to make strings, especially guitar, and in the mouthpieces of woodwind or brass instruments. Where sensitivity exists, alternatives like nylon strings and plastic or gold mouthpieces should be considered.
Contact with certain exotic woods has also been linked to dermatitis. Violin and viola players are particularly at risk, since these woods are often used in chinrests.
There are also a number of instrument-specific conditions relating to the various points of contact between the body and the instrument. They include fiddler's neck, cellist's chest, guitar nipple and flautist's chin.
These conditions are the result of persistent friction between skin and instrument, often aggravated by heat and moisture. Cellists, and particularly guitarists, can avoid such conditions by adapting their positioning relative to the instrument, to minimise friction.
Woodwind and brass instrumentalists should also be wary of using each others' instruments. Skin infections such as herpes labialis can easily be caught from the mouthpiece of a saxophone or clarinet.
Calluses – a common problem
When starting out on the guitar or other stringed instruments, you need to develop calluses, a layer of hardened dead skin, on your fingertips. This will help protect your skin from the pressure and friction of fretting the strings.
The best way to develop calluses is simply by playing your instrument. Keep going until your fingertips start hurting a bit, put your instrument away, and do the same again the next day. Playing until your "fingers bleed" is not smart.
Alternatively, many guitarists swear by rubbing alcohol on your fingertips three times a day.
Once you have developed thick calluses, the best way to maintain them is by regular playing. They may peel off from time to time, but that is a natural part of the process.
(Marcus Low, Health24, August 2005, updated July 2007)
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