Violinist

Western Pennsylvania is well-known as a hotbed for sports, producing outstanding athletes at every skill level — from youth players and weekend warriors to elite high school, college, and professional athletes — and in a wide range of sports.

The region is equally well-known for producing a wide range of intermediate and advanced musicians — athletes with fine motor skills — who teach and play in elite concert settings at schools and colleges, and perform with professional bands, orchestras, and symphonies.

Just like their peers in sports, these fine motor athletes are equally prone to injury — but far more likely to play through the pain rather than rest and rehabilitate.

Michael Tsang, PT, DPT, a doctor of physical therapy and an orthopaedic resident with UPMC Sports Medicine, is hoping to change that. He is developing a niche specialty to help musicians with performance-related injuries.

A concert pianist himself, Dr. Tsang played with the Pittsburgh Youth Symphony Orchestra while in high school. He earned bachelor’s and master’s degrees in music at the Cleveland Institute of Music while simultaneously earning his undergraduate degree in biology at Case Western Reserve University. He completed his doctor of physical therapy degree at Washington University School of Medicine in St. Louis.

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Playing-Related Injuries in Musicians

“Musicians mainly sustain overuse injuries from playing their instruments,” says Dr. Tsang. “Many college and professional musicians have changed careers because of chronic pain. Playing a musical instrument is very task-specific and physically demanding — requiring fine motor coordination to play the instrument and using larger muscles and asymmetrical postures to hold the instrument. Add in the significant time dedicated to practicing and honing their craft and that sets up the perfect storm for an overuse injury.”

Music-related overuse injuries can occur in different parts of the body, depending on the instrument being played.

For string musicians, injuries tend to occur in the upper body, including the chin, shoulders, neck, upper back, wrists, and elbows. They often experience numbness or tingling in one or both hands due to how they hold their instruments.

For woodwind and brass musicians, injuries tend to be in the jaw, neck, tongue, lips, wrists, and fingers.

For keyboard musicians and percussionists, playing injuries are common in the wrists, elbows, and forearms. They also can experience neck and back injuries from their position on the seat or bench.

“Many professional musicians do not report pain or an injury for fear of losing their job or being told to stop playing,” says Dr. Tsang. “In addition, musicians do not like to modify their playing position or technique — even if it means less pain — because positional changes can affect the tonal quality of the music.”

But injured fine motor athletes who take a page from the rehabilitation book of their more traditional athlete peers can lessen their playing pain and maintain sound quality.

“My goal is to optimize the way they play their instrument to improve their pain and physical performance without affecting how the sound is produced,” he says. “With efficient movement patterns and good balance, musicians can have the greatest control of their instrument and sound quality without physical limitations.”

Specialized Rehab for Musicians

Similar to the approach for traditional athletes with overuse injuries, Dr. Tsang’s rehab protocol for a fine motor athlete starts with adequately resting the injured body part. It is unusual that a musician would have to completely stop playing to rehab appropriately. More likely, they can reduce their playing time, frequency, and intensity and incorporate pain-free practice strategies to allow for healing.

Next, Dr. Tsang has the patient bring their instrument and play it for him so he can evaluate the biomechanics of how they play.

“Most biomechanical issues involving movement compensations or excessive muscle tension are due to overuse compounded by a lack of strength, flexibility, and endurance of the complementary muscle groups,” he says.

“That’s where the final step comes in — a personalized physical therapy and rehabilitation plan. We can outline a rehab cross-training program to work on mobility and strength of the specific joints and muscles they use to play their instrument, as well as the core and supportive postural muscles to maintain a balanced musculoskeletal foundation.”

To musicians who are experiencing pain from playing their instruments, Dr. Tsang says they should talk to a professional.

“Musicians should talk to their PCPs, physical therapists, or chiropractors if they are in pain when playing their instruments — just like an athlete tells the trainer,” says Dr. Tsang. “Don’t push through the pain. The earlier you get help, the faster you can proactively manage the pain. And with the appropriate rest, physical therapy, and rehab, fine-motor athletes can get back into action.”

For more information about physical therapy and rehabilitation for musicians with playing-related injuries, call UPMC Sports Medicine at 1-855-937-7678 or contact us online.

Sources

Dr. Michael Tsang

About Sports Medicine

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