Most musicians have heard of repetitive strain injury, but do you know why it happens to you and how you can safe guard against it?
What is Repetitive Strain Injury, RSI?
Most Repetitive Strain Injuries (RSI) are often put down to the length of time you spend in (often awkward) positions. But there is more to it than that.
RSI or WRULDS (Work Related Upper Limb Disorder) is a collection of symptoms (pain, pins and needles and numbness), usually starting in the wrists, arms and upper back. Problems begin vaguely but can start suddenly after a long and intensive bout of playing. Many structures in the hand, arm and back can be involved and each person has a different set of problems, so correct diagnosis is essential.
If your symptoms become long-term they can be difficult to reverse, so get treatment early when you begin to have problems. Treatment for RSI not only involves the areas of pain (which often appear in the wrist and hand), but the muscles, joints and nerves which refer symptoms into the area of pain. It is essential to treat all areas, as the problem often stems from the spine and nerves, even if your symptoms are only concentrated in the hand and arm. Your physiotherapist will thoroughly assess which structures you need treated.
Classic cases of RSI usually involve problems with:
- The spine (neck and upper back)
- The nerves of the arms (98% of sufferers have problems with their arm nerves)
- Muscles in the back, arms and shoulders- these commonly refer pain down the arm
- Local inflammation and irritation of structures in the arm
So how does RSI start?
When a person stands normally, the spine has 4 curves, which act as shock absorbers during movement.
The muscles, nerves, discs and other tissues, all work minimally to maintain upright posture. A person does not generally stand still for long without moving and thus blood circulating through the muscles helps to prevent fatigue.
However, while sitting, the spine usually becomes one long curve. This produces 1.5 times the normal forces through the discs in the spine than in standing. Approximately 70% of people's waking hours are spent sitting including work and leisure (driving, TV, movies, internet, play station etc).
The curves in the spine are linked by muscles, nerves and other tissues and if one vertebrae is strained, the others tissues are affected, often sending symptoms into the arms, wrists and hands. The muscles around the back of the curve work harder to prevent further curvature and the muscles around the front shorten and weaken. The discs between the vertebrae are squashed as they work to absorb the added pressure from sitting.
Damage to the tissues occurs when the person is concentrating so hard that they ignore the pain that is telling them to shift position, which prevents healing; this damage over time becomes can become difficult to repair.
Our tissues stiffen as we get older so long sessions of sitting will cause your muscles to tighten faster and you will be at greater risk of strain and injury when you move.
Musicians who work in a fixed posture with few breaks and intense concentration are at a greater risk of RSI. The most common injuries are to the neck, shoulders, arms, which often spread symptoms to the wrists from the bundle of nerve fibres in the area of the collar bone.
8 Tips to Stay Healthy and Pain Free Playing
Keep a strong shoulder posture. Yes, just what your mother told you to do! To do this, you need to square your shoulder blades out using the muscles in the middle of your back whilst you play or sing. For all instrumentalists, this takes much of the strain away from the arms and supports you as you play.
If your shoulders are rounded, you may need treatment to loosen out the muscles and joints which keep you in this position. Your Physio will give you specific exercises to improve your back muscle control make it easier to play.
Improve your fitness, general health and nutrition. This improves the condition of your muscles and joints, helping any strained muscles to heal faster.
Get yourself assessed for playing ergonomics. Your Physio and instrumental teacher can help you with this. Look at our ideal ergonomic diagram, designed for computer workers and equally applicable for musicians such as keyboard players and drummers. Come in and discuss your individual needs with us.
Take regular breaks an hourly clock strike is a great way to help you remember.
Do regular stretches during your breaks. Your Physio will show you the best ones to do.
Change your position frequently, practice in standing and sitting.
If you are suffering from playing continuously, you must take micro-breaks at least every 4-6 minutes, for 20 seconds i.e. STOP for 20 seconds.
Remember, get treated quickly if you have aches and pains, pins and needles or numbness...never wait!