Can the Number of Musicians with Repetitive Strain Injury be Reduced if Preventative Measures are Taken
This project looks at the possibility of lowering the number of cases of repetitive strain injury (RSI) in musicians. By delving into the lifestyles of musicians and studying how various factors and preventative techniques correlate to RSI, a more coherent understanding of the demands on a musician’s body is gained. Musicians are compared to athletes with similar injuries and various studies on computer users and the effects of training on the rates of RSI are described. A questionnaire was distributed to 150 student musicians and an interview with a physiotherapist specialising in RSI was conducted. It is evident that musicians are commonly misusing their bodies, the rate of RSI can be lowered, and the problem can be prevented on a much larger scale than it currently is. However, the problem of musicians misusing their body is not due do the demands of their instrument and lifestyle, but as a result of not knowing how to appropriately deal with RSI and to treat their bodies in such situations. For the most part this is due to a knowledge gap present within the education system, teaching schemes and musicians, and until this changes the rates of RSI in musicians will not decrease.
Table of Contents
List of Figures
Research suggests that in recent years the cases of repetitive strain injury (RSI) have soared. RSI is an umbrella term for a number of overuse injuries affecting the soft tissue of muscles, tendons and nerves (Bowley, 2006). Overuse injuries develop over a long period of time as a result of a movement being repeated thousands of times without adequate rest and often with bad technique. In addition, lifestyle factors, such as stress, muscle conditioning, cold, and computer use, can be catalysts for developing RSI (Llobet and Odam, 2012). Several studies have investigated the rise in cases of RSI and looked at:
- The correlation between computer use and RSI.
- Comparisons between drummers and professional footballers.
- Computer training and the reduction of RSI.
- In athletes, specifically tennis players.
- The performance of symphony orchestras.
- Policies and procedures related to RSI cases.
Despite the various studies conducted, musicians and RSI have received little attention, especially concerning preventative techniques and the identification of the numerous factors involved in RSI. Preventative techniques include anything that can delay or prevent the onset of RSI, such as taking regular breaks or using the correct technique, and this will be covered more in depth later on. In my primary research I distributed a questionnaire to musicians and conducted an interview with an industry professional who has acquired a wealth of experience in helping people recover from RSI. The purpose of this study is to link the various lifestyle factors of musicians to their high rates of RSI, and to show that preventative methods can reduce the risk of RSI. This study contributes to music understanding and demonstrates that with the right knowledge, the number of musicians with RSI can be reduced.
RSI is epidemic in the 21st century, with approximately one million workdays being lost due to RSI in 2006 / 2007 (Chartered Society of Physiotherapy, 2008). However, it wasn’t always such a problem, as in 1982 RSI accounted for only 7% of work related medical claims, whereas by 1992 this had risen to 56% (Heilbonner and Mcdonald, 1993). During the 1980s there was a clear rise in the number of work-related cases of RSI. This decade witnessed huge technological developments, with the advent of the first Macintosh, Microsoft Windows, personal computers, the World Wide Web, space invaders and Nintendo (Bellis, 2015). The dramatic increase in use of this new technology is likely to have triggered the sharp rise in RSI.
In 1995 a survey on RSI and computer use was administered to graduate students who were employed full-time in businesses and organisations (Macdonald and Wood, 1995). In total, 103 students were asked if their company/organisation recognised RSI computer use as a problem (Figure 1), followed by how many people they knew within their company that had been treated for RSI (Figure 2). The two charts correlate almost exactly, and although it is not known whether these companies diagnosed RSI as a problem before the RSI occurred, due to the similar nature of the results it is likely these companies only noted RSI as a problem after their employees had been affected. Despite RSI being a large-scale problem, companies continue to overlook the importance of educating their employees to prevent injury, with only 20% of the students knowing about policies and procedures at their workplace which address RSI.
(Source: Macdonald and Wood, 1995)
Figure 2: Responses to the question ‘Has any one in your company been treated for Carpal Tunnel Syndrome as a result of using a computer?’
(Source: Macdonald and Wood, 1995)
From the evidence provided, education is the first and most important step to preventing and reducing the risk of an individual experiencing RSI. John Deere & company began training programmes for their computer users in 1986 (Kleiman, 1994) and have since had an 86% reduction in time lost due to carpal tunnel syndrome. Whilst policies and procedures are an important part of preventing RSI, the issue is a lot more complex. The physical stress of a repetitive motion is the main contributor to tissue breakdown, but there are other types of stress which can also contribute to the breakdown of tissue. Types of stress responsible for tissue disassembly can be separated in to three subcategories (Jameson, 2004):
- Physical stressors – anything that stresses the physical body, such as bad posture, bad technique, overplaying, not resting enough, playing computer games too much and weightlifting.
- Chemical stressors – substances put into your body, such as alcohol, caffeine, bad diet and drugs.
- Emotional stressors – things that affect you emotionally, such as relationship problems, debt, being on tour away from friends and family, grievance and performance anxiety.
Culf (1998) additionally identified several other factors that contribute to the onset of RSI:
- Misuse or inefficient use of the body
- Lack of general fitness
- Chronic muscle tension
- Undeveloped upper arm, shoulder and back muscles
- Stress (physiological or emotional)
- Playing ‘cold’, i.e. without warming up the muscles before practicing
- Insufficient rest breaks
Often, even music teachers who do make their students aware of RSI and their health will focus on technique and biomechanics but will forget about taking breaks away from the instrument or health factors outside of the instrument, such as general fitness and diet. A dietician looks at diet, whilst a doctor would prescribe pills, and often it is only specialists in RSI who look at the entire human body and lifestyle. Dr. Timothy Jameson, a chiropractor reported a case study of an individual who had deep tissue pain in the forearms after three weeks of intense computer usage. Pain had flared up within his tendons and the connective tissue had broken down due to sheer overuse of his hands and forearms (Jameson, 2004). Anti-inflammatory tablets were prescribed, ergonomic computer equipment was purchased, and it was recommended that a wrist splint be worn for support. Instead of addressing the fact that the individual’s hands had been used too much and prescribing rest and stretching to ease the problem, painkillers were used to try and cover up the problem, with the hope that the RSI would subside. Figure 3 depicts the imagined importance of biomechanics, overuse, inflammation, muscle fatigue and head games versus their actual importance in RSI. Rest and muscle fatigue are much more of an issue problem, but both the patient and the chiropractor in the case study thought that biomechanics, i.e. movement patterns and ergonomic computing equipment paired with anti-inflammatories were the immediate answer to solve the problem. If the patient had better initially informed about his RSI then his recovery may have been a lot quicker.
Figure 3: The imagined importance of RSI factors versus their actual importance
Despite the high demands of a musician, there are no policies and procedures within the music industry to protect the health of musicians. Many players are taught in schools, colleges and by private teachers, where it is largely down to the teacher in charge or the school to create their own curriculum. Unfortunately for the students, many private teachers do not need formal qualifications to teach, and even teachers in private schools require no qualifications (Kennedy, 2014). Whilst such teachers may excel in technique, they are often not aware of anatomy and physiology and how the body works.
In an experiment, Dr Marcus Smith connected a professional drummer, Clem Burke, to equipment that could measure his heart rate, oxygen uptake and lactic acid levels in his blood (BBC, 2008). Burke drummed for 90 minutes, with his heart rate averaging at 140-150 beats per minute and peaking at 190bpm. This is similar to that of a professional footballer, but whereas a footballer will only play games once or twice times a week, a professional drummer would be expected to do perform every night for 30 days. Subsequently, when the demands of drumming and other instrument disciplines are being taught, the warm up process and importance of stretching should be stressed as being equal to that of a professional athlete. Most musicians undermine the stress of their instrument and simply start to practice or playing without warming up; if a professional footballer did this then they would most likely pull a muscle or injure themselves.
Another demanding professional sport is tennis, and this is an extremely repetitive sport with 40% of tennis players suffering from ‘tennis elbow’ (Bisset, Vicenzino, Sesto and MacDermid, 2012). This is a form of RSI caused by overuse of the muscles and tendons of the forearm near the elbow (NHS, 2014). The injuries suffered by tennis players are very similar to those suffered by computer programmers or musicians. However, most musicians do not approach their instrument as a tennis player would approach a match, and consequently musicians generally suffer a lot more injuries than sportsmen. A survey conducted amongst symphony orchestras found that 64% to 76% of musicians were experiencing RSI that affected their performance (Culf, 1998), and due to the survey sample, this didn’t include musicians who had already abandoned their musical career due to RSI.
Due to the extremely limited amount of research concerning musicians and the different variables that affect their bodies, I created an in depth questionnaire to address this issue. Utilising the knowledge already gained from previous studies, such as how training positively affects rates of RSI and how levels of RSI dramatically rose in the 1980s with the arrival of new technology, coupled with knowledge of the three stress factors that cause tissue break down and identified as the main causes of RSI in musicians, I created a survey tailored to musicians (see Appendix A).
The subject group for the questionnaire was 150 musicians, ranging in age from 15 to 50 and over. The respondents played a variety of instruments, including guitar, bass and 80% were drummers, this is because drummers were the main group of musicians available to complete the survey. Participants were first asked a series of general questions to gain background knowledge, such as if they have received formal training, did they include rest periods during practice/gigs, and the length of time they spent on technology, as these have all been previously identified as crucial variables in RSI. This created data on both healthy musicians and musicians previously or currently experiencing RSI. Respondent who weren’t sure if they had RSI or who had definitely had RSI were directed to the second section of the survey in order to gain further insight into their personal case of RSI, including what caused it, the three types of stress, what makes it feel better, and how they first approached the problem. Finally, both groups were asked to optionally expand on their case or on why they think they had never experienced RSI. All the results are presented as rounded to the nearest percentage.
After gathering data from the musicians via the questionnaire, I conducted an interview with Drusilla Redman to gain a professional opinion from someone who treats performers and musicians. The interview was transcribed verbatim and can be read in full in Appendix B. Drusilla Redman is a physiotherapist employed by the British Association for Performing Arts Medicine. This is a unique organisation which aims to help performing arts professionals and students with work-related health issues, both physical and psychological. In addition, she is the physiotherapist for The Guildhall School of Music and Drama.
Results and Discussion
As training has been noted as important for the prevention of RSI (Kleiman, 1994), participants in the study were first asked if they had received training on their instrument that focused on their health, posture and potentially experiencing RSI. In total, 37% responded that their training had not included this, and an additional 13% hadn’t received any training at all. Rest breaks from an instrument were also identified as one of the most important prevention strategies, and it is recommended that 45 minutes to an hour is the maximum anyone should play for without taking a break, while a break every 25 to 30 minutes is highly encouraged (Bruser, 1997). Participants were asked how often they took breaks; 44% stated that they take breaks every 1 to 5 plus hours (Figure 4), which places a large percentage of the players at high-risk. When asked the same question for use of mobile phones / computers / laptops, 62% of the musicians answered that they breaks every 1 to 5 plus hours (Figure 5). Despite being proven to be a critical factor in accumulating RSI, people seem less aware or more ignorant to the damage that technology can do.
Figure 4: Responses to the question – How often do you take breaks when playing your instrument?
Figure 5: Responses to the question – If you use a laptop, mobile phone, tablet or gaming device for long periods of time in one go, how often do you take breaks?
Figure 6: Responses to the question – How much time per day do you spend on a computer, laptop, mobile phone, tablet or gaming device e.g. Xbox?
When participants were asked if they had previously or currently have RSI, 29% had not, while 71% responded ‘yes’ or ‘not sure’. This figure of 71% correlates perfectly with Culfs (1998) figure of 64% to 76% of orchestral musicians in pain.
To gain further insight, musicians that answered ‘yes’ or ‘not sure’ were then asked ‘What caused your condition if you know?’ and a box was left for participants to write in. The most commonly believed cause was technique, followed by overplaying. When asked what makes their RSI feel better, 58% replied stretching, while 30% responded with sleep. Figure 3 demonstrated that the perceived most important factor in RSI is technique but in reality the most significant factor is overuse, followed by muscle problems, which will be rectified by sleep and stretching.
Out of the 106 respondents, 42 said practice and gigs makes their RSI worse, while 42 also said cold exacerbates the problem, and 25 responded that stress contributed to their injury. Not a single participant identified stress or cold as causing the issue or that a lack of stretching and lack of sleep affected it. Furthermore, despite clearly identifying what made their problem feel better and feel worse, the participants still focused on technique as the root cause of the issue. When developing the warning signs of RSI, such as tingling, weakness and tiredness, 46% of the musicians thought that the pain would go away; consequently, they continued to play through the pain and developed chronic problems. This is not a fault of these musicians, as there is a gap in the teaching curricula regarding making musicians aware of the early signs of RSI and how to prevent the problem or what to do if you already have it. Even the Jameson (2004) in his case study didn’t evaluate the three types of stresses accurately, and instead prescribed ergonomic assistance and anti-inflammatory tablets in the hope that the pain would go away.
Drusilla Redman has treated both athletes and musicians for over 10 years and has an extremely wide range of experience. Her first observation was that the way highly skilled musicians are treated is absolutely no different to the way athletes and gymnasts are approached, as supported the comparison between footballers and drummers by the BBC (2008). The musicians she treats all share in common the fact that they lack knowledge of how the three types of stress (Jameson, 2004) can all affect their body, and they don’t understand the importance of warming up and forget about everything away from their instrument / sport, such as rest and nutrition.
A lack of knowledge in how the three stressors affect the body is a fault within the teaching profession, as most teachers are taught by teachers and old habits are passed down, with most private teachers not requiring formal training before teaching meaning that they can’t pass on vital information about health and RSI. One of the main differences between sports people and musicians is that sports people know when to rest their bodies because if they get injured then they can’t compete. However, musicians live with a fear that they can’t stop playing, and consequently, a problem that could usually be fixed within a few weeks becomes a chronic problem that could eventually even end their career. The main points identified by Drusilla Redman in preventing RSI were a graduated return to playing, hydration, warming up and stretching.
It is evident that there are many factors that contribute to a musician developing RSI. From studies conducted away from musicians it is known that the use of computers is detrimental to health if used incorrectly. The health of a musician is complex; not only do they spend hours every day practicing on their instrument, they also spend a lot of time on computers, with the questionnaire revealing that the average musician spends 3 to 6 hours a day on mobile phones / laptops / computers. The combination of unnatural stresses on the body places musicians at a much greater risk of RSI, even higher than that of typists and professional tennis players. It has been shown that the negative effect of computers can be lessened if correct training is provided, and this is also true for musicians and their instruments. However, most tutored musicians are taught to focus on technique and practice, and often forget about the importance of rest and the overall harmony of the human body.
This research has addressed how different factors increase the severity or chances of RSI and has compared musicians to sportspeople and other repetitive professions. The main negative factors identified are overplaying, stress, cold and bad technique. In addition, musicians should counteract these by using effective preventative techniques, such as stretching, sleep, rest and a good playing technique. It was identified that most musicians think bad technique is the main cause of RSI, and while it is a factor, it is a less significant one. This common belief is due to tutoring and teaching focusing on improving technique to stop pain, whereas resting more is often the more appropriate response.
To further this research, areas of future study should include:
- The effects of computer training on musicians and their RSI.
- Musicians and sports, how the two can affect each other.
- How different break lengths away from repetitive activities help to prevent injury.
- An assessment of music teacher training and determination of the focus on anatomy and physiology.
- Rates of RSI in students when taught by professionally trained music teachers versus private music teachers with little or no qualifications.
As Redman (2015) stated; “If prevention was the law, then amounts of pain, injury and suffering would be much less but until teachers have that as part of their curriculum it’s not going to happen”. Preventative measures have been proven to be extremely effective when implemented by musicians. However, the reason why there are so many musicians with RSI is not due to the ineffectiveness in preventive techniques but because of a lack of knowledge concerning what they are and how to implement them. Most musicians don’t know what is good and bad for their body, and only find out that prevention is the best cure for RSI when it’s too late. The RSI epidemic stems from the way the music education system has been established, and a change in education procedures and a greater emphasis on RSI through correct training and knowledge needs to be taught, as this is the most effective way to reduce RSI. Until this change occurs on a large scale, it is unlikely that the rate of RSI in musicians will decrease.
Reference List / Bibliography
BBC (2008) Rock Drummers ‘are top athletes’. Available at: http://news.bbc.co.uk/1/hi/health/7518888.stm (Last Accessed: 3 March 2016).
Bellis, M. (2015) 20th Century Timeline. Available at: http://inventors.about.com/od/timelines/a/modern_4.htm (Last Accessed: 12 March 2016).
Bisset, L, MacDermid, J, Sesto, S. Vicenzino, B. (2012) Tennis Elbow: The Science and the Clinical Experience Available at: http://www.physio- pedia.com/conferences/ifompt/tennis-elbow-the-evidence-the-science-and-the- clinical-experience-focused-symposium/ (Last Accessed: 2 March 2016).
Bowley, T.C. (2006) RSI How to avoid it, Canada: Tonia Cope Bowley.
Bruse, M. (1997) The Art of Practising: A guide To Making Music From the Heart. New York: Bell Tower / Harmony Books.
Chartered Society of Physiotherapy (2008) Sharp rise in rates of repetitive strain injury. Available at: http://www.csp.org.uk/press-releases/2011/02/25/sharp-rise- rates-repetitive-strain-injury-physiotherapists-call-urgent-act (Accessed: 6 March 2016).
Culf, N. (1998) Musicians Injuries: A Guide to Their Understanding and Prevention. Tumbridge Wells, Parapress Ltd.
Heilbonner, D. and Mcdonald, R. (1993) ‘The Handling of an Epidemic’, Working Woman, 18(2, February), pp. 32-33.
Ingraham, P. (2015) Repetitive Strain Injuries Tutorial, Pain Science. Available at: https://www.painscience.com/articles/repetitive-strain-injuries.php (Last Accessed: 8 March 2016).
Jameson, Dr.T (2004) Musicians Health. Available at: http://www.musicianshealth.com/whyrsi.htm (Accessed 7 March 2016).
Kennedy, R. (2014) Do Private Schools Require Teachers to be Certified? Available at: http://privateschool.about.com/cs/employment/a/certification.htm (Last Accessed 1 March 2016).
Kleiman, C. (1994) ‘John Deere & Co. Leads the Fight Against Repetitive Stress Injuries’, Providence Journal, 10(November), pp. 29, 77-78.
Llobet, J. and Odam, G (2012) The Musicians Body. Barbican, London: The Guildhall School of Music & Drama.
Macdonald, L.E. and Wood, W.A. (1995) Referred Proceedings-International Association For Computer Systems Conference: Professional Issues In Information Comptuer Systems, A Survey Of Repetitive Strain injuries (RSI) and Computer Use. Toronto, Canada, 30 September. Toronto: Nelson Education pp. 485.489.
NHS (2014) Tennis Elbow Available at: http://www.nhs.uk/Conditions/Tennis- elbow/Pages/Introduction.aspx (Last Accessed: 10 March 2016).
Appendix A – Questionnaire
This questionnaire was created by Ryan Barnes and released 6th March 2016 and closed 8th March 2016
Title – Musicians and Repetitive Strain Injury
Section 1 – General Questions
What is your main instrument?
Have you had have training on your instrument?
Did the training focus on health, posture, technique and warn of you of possible related injuries such as RSI?
How old are you?
Younger than 15
On average, how much time per day do yo u spend on a computer, laptop, mobile phone, tablet or gaming device e.g. x-box?
Less than 30 minutes
more than 6 hours
If you use a computer, laptop, mobile phone, tablet or gaming device for long period of time in one go, how often do you take breaks?
Every 15 Minutes
Every 30 minutes
Every 45 minutes
Every 1 hour
Every 1-2 hours
Every 2-4 hours
Every 5+ hours
How long do you play your instrument for on average per day?
Less than 30 minutes
30 minutes to 1 hour
1 to 2 hours
Do you warm up before you play?
How often do you take breaks when playing your instrument?
Every 20 minutes
Every 30 minutes
Every 45 minutes
Every 1-2 hours
Every 2-4 hours
Every 5+ hours
Do you suffer from performance anxiety?
Not at all
All the time
Regardless of how it occurred or how long the pain lasted, have you ever suffered (or still do) with any repetitive strain related injury?
Section 2 – Repetitive Strain Injury, Pain and Treatments
What caused your condition if you know?
What makes your problem feel worse?
Practise / gigs
Lack of sleep
Bad diet or certain foods
Gym routines, lifting involving the affected area
What makes your problem feel better?
Cold / Ice
Anti-Inflammatory or painkiller drugs
Gym routines, lifting involving the affected area
Practise / Gigs
When you had warning signs of injury e.g. numbness, tingling, weakness, tiredness and pain, how did you respond?
I took the precautionary actions to fix the issue
Didn’t understand why I had the symptoms
I thought they would go away over time
I didn’t suffer with any of these
What is or was your Doctors response?
Prescribed anti-inflammatory / Painkillers
Haven’t seen a doctor
Didn’t really help
What self help do you find is or was helpful for your RSI condition?
Treatments received and their success rate for you
|Medication – conventional|
|Medication – nutritional|
|Special stretching exercises|
Section 3 – Final Section
If you’ve never suffered with RSI, why do you think you’ve never had pain or injury? Did you use any preventative techniques?
Would you like to expand on your story any further?
Appendix B – Interview with Drusilla Redman
Drusilla Redman was interviewed by Ryan Barnes at the Guildhall School of Music & Drama on 9th March 2016, 3:30pm
Me: What is your background, training, jobs that relate to your profession and helping people with RSI?
Drusilla: I started in the late 80s working with sportsmen and sportswomen, mainly junior athletes, junior gymnasts and some tennis players. In this century I changed to working with performers, it’s absolutely no different to working with highly skilled athletes. The performers I have treated are anything from musicians, actors, street, performers, aerialists, tumblers, gymnasts and stuntmen.
Me: You’ve treated a wide range of people, if you could pick some main causes of why all these athletes and musicians get RSI what would it be?
Drusilla: It’s a lack of ability to know what their bodies need. For instance, they don’t know how their bodies work; therefore they have no idea why a warm up is so important. They don’t think about everything else attaining to health; rest, really good nutrition, keeping hydrated, and not working when they’re over tired.
Me: Do you think that the people that don’t know how to look after their bodies properly, is it a fault in the education system?
Drusilla: It’s a fault within the teaching profession, most teachers don’t know how bodies work for the main part, that’s historical because quite a lot of our best teachers have come down from great teachers in the nineteenth century and they teach like their teachers taught. This way, they don’t necessarily learn how bodies work. If you don’t know how your body works then you can’t explain to a student how they should be looking after their bodies. There are a lot of myths in the musical world especially about how musicians shouldn’t exercise, shouldn’t work out, shouldn’t train their bodies because they might get muscle bound. What does muscle bound mean? It doesn’t mean anything, it’s a term that’s just used and nobody really knows what it means. I’m not talking about bodybuilding, I’m talking about actually toning bodies and conditioning bodies so they work best whatever their owner wants them to do.
Me: So from the back of that, generally the musicians that you see, are they generally bad shape physically?
Drusilla: Yes they are
Me: So you wouldn’t have anybody that’s fit, great posture and strong to treat?
Drusilla: Yes you do have those because when I worked with athletes who were fit, extremely strong and looked after their bodies, there is always the chance that you will injure a part of your bodies, maybe if there is too many competitions all at once, or a competition has gone on longer than they expected. For example, in a long jump competition, the competition may keep jumping the same length so they have to keep jumping until somebody wins and that’s when the body will break down. You will always get injuries, it’s part of the life of sports people and musicians, but musicians particularly. Not necessarily dancers or gymnasts because they look after their bodies. Musicians seem to be a breed alone and they have left sport in their early teens because they joined the orchestra or the choir and then exercise goes out the window. They start playing too much, practicing too much without a care in the world, and doing something that is most unhealthy and very body unfriendly. There is no instrument that the body takes to. They’re all difficult, with difficult postures and difficult movements, for hands and fingers the movements are not at all natural.
When you think about what the body should be doing, that would be catching supper, picking berries or building a home, not spending hours plucking strings, banging drums or playing any number of instruments that are really unfriendly towards the body.
Me: Would you say that the advice and treatments that you would offer and give, would it differ between a musician and an athlete?
Drusilla: No. The advice doesn’t alter; it’s all about warming up the relevant parts of the body, well the whole body actually. It’s about not doing too much; in actual fact sports people don’t do too much because if they get injured they cant actually play their sport and enter competitions. Whereas musicians have this fear that they cant stop playing whatever injury they have or whatever pain they have they’ve got to carry on playing. This is something that they’ve been almost brainwashed into thinking, that if you do have an injury as a musician you’ve got to grin and bear it. “No pain no gain”, “everybody has pain playing an instrument, you have to expect the pain” etc. Therefore they won’t stop, making the problems worse, making a comparatively easy problem extremely difficult as it becomes chronic as time goes on.
Me: Do you think that with an improved education system, especially private teachers, the amount of people that you see and treat would massively reduce?
Drusilla: If prevention was the law, then amounts of pain, injury and suffering would be much less but until teachers have that as part of their curriculum its not going to happen. The other thing that happens, especially in the musical world is that music teachers become teachers when they either stop performing or as an addition to their performing. They’ve not necessarily been trained as teachers, so the formal training of music teachers is very rare. Even on music teacher training courses I’m not sure anatomy and physiology and how the body works is on their curriculum.
Me: What would you say the most important preventative techniques are?
Drusilla: The top things to prevent injury would be a graduated return to playing after a break, i.e. somebody doesn’t have a 3 week holiday then go back to playing 6 hours a day. I would say that actually shortening the length of a practice routine is a much better way of working. So that practice is deliberate and not thought about in terms of hours and that mental practice should be taught from a really early age. It’s just as efficient as physical practice and obviously saves the body. Then of course, the warm up, it has to be high up there along with stretching the appropriate joints when the body is warm. Some people’s bodies are hypermobile; if that’s the case then they don’t need stretching. Some people have hypermobile joints, it’s about them finding out which joints are stiff joints, which joints and hypermobile joints and then using stretching appropriately. There is no point in stretching a joint that has a massive amount of movement already in it. Stretching out tight joints, yes. Hydration, keeping the body hydrated is paramount because we are 72% water and once we are thirsty we are already dehydrated and it takes 4 hours for the body to rehydrate.
Me: In 1982 RSI accounted for 7% of work related medical claims, in 1992 it had risen to 56%, this was during the introduction of mobile phones and computers to the world. Do you think that technology is perhaps a bigger problem than the instrument itself?
Drusilla: It contributes to the problem because it’s the same muscle mechanisms that are being overused. When people are on their laptops for maybe 4-5 hours a day and they’re doing 4-5 hours of practice and then mobile phone usage, it really doesn’t help to have the amount of technology that people have. Musicians should keep technology until weekends when they’re not on their instruments. Weekends free of instruments, and weekdays free of technology – even then you still can’t get a rest. I believe that musicians should have one day off a week, including technology to allow their bodies to recover from the minor trauma that happens in the muscles, ligaments and tendons. It needs time to heal; a day off a week is a really good idea.
Me: My RSI has felt the most delicate it has been in months because I’m typing so much for my dissertation.
Drusilla: I’m not surprised, even this you need to take breaks, warm up before, rest during, stretch after.