3.2. Reviewing the correspondents
As the interviews suggest, the onset of the injuries of the subjects have many similarities. A new stimulus, such as a new playing technique, enters and that requires the use of a new muscle structure. Katarina Porander and dr. Þórarinn Ingólfsson both stressed the importance of making changes gradually. ”Changing playing technique, practice habits or even changing the music does increase the risk of injury” (Porander, 2020). As Ingólfsson (2020) puts it, “if you do not use it, you lose it” while reiterating that changing habits too suddenly makes us susceptible to overuse injuries.
All of the subjects did seek help. Looking at this data, it can be argued that going to a general physician is maybe not the best idea for musicians as seen in Kato’s and Sissel’s cases. Dr. Ingólfsson commented that a general physician is not always going to give the patient an exact diagnosis and will most of the time prescribe rest and anti-inflammatory medication. But if he sees the patient needs help beyond their expertise, they will send the case onward to a physical therapist or a hand specialist (Ingólfsson, 2020).
Diagnosing overuse injuries is also not an easy task and is maybe not always the goal. Out of these six cases, only two got a clear diagnosis. However their symptoms can often reveal the cause.
Katarina Porander (2020) noted that overuse injuries almost always start from the muscles. Muscle fatigue makes the muscle tight which can lead to poor circulation, entrapped nerves and will expose the tendons.
We can therefore estimate where each one of the subjects lies in the chain of reactions.
Arnold’s case comes from needing to use new group of muscles, which then tire easily, exposing his tendons leading to a tendinopathy. The ending -pathy in tendinopathy refers to general damage in the tendons.
Kato and Robert had similar stories using too much force for too long, leading the tendons taking the hit.
Sissel overused her muscles which put pressure on the tendons and between the tendons, a ganglion formed . “Even though we do not know what causes a ganglion, we can tell it is related to overuse” (Porander, 2020).
For Alex and Christian the diagnosis is not as clear cut but still with muscle fatigue as a source of the symptoms. Christian felt tingling in his arms and Alex experienced loss of a grip strength but they share a similar cause. Anything that has to do with the nerves, sometimes results in weakness without pain and a tingling sensation. Feeling of an electric-like current suggests it could be nerve related according to Katarina Porander (2020). Muscle overuse can take many forms (Healthline, 2005-2020), one of them is restricting and damaging the nerve ends which makes the recovery time much longer.
Looking at the length of the injuries (Table 1) for each correspondent, we can see that their injury times were very different. It should be noted that Sissel had to have surgery and has only recently been cleared to play and Christian is still working on his recovery. We can see that Kato and Robert have relatively shorter times of injury and recovery than others. There does not have to be a specific reason for this other than their injuries were not as severe they had clear tendon injuries. Even though Christian’s and Alex’ time away from their instruments was not very long, their recovery is slow which can hint that the injury was nerve related. As Katarina Porander (2020) puts it, “nerve injuries are always much slower to recover and need a longer recovery process”.
Time away from the instrument is not something musicians are used to. All candidates except Robert described parts of their process sad, frustrating and depressing. Some showed some good initiative to combat the inactivity and time away from instrument. Christian, Kato and Arnold all talked about some kind of score study to fill their time, trying to fill their times with mentally challenging task. All correspondents talked about their first steps back being very experimental in finding ways to apply themselves back behind an instrument.
When discussing their return to practicing, some interesting information came to light. All of the correspondents talked about static stretching as being a regular part of their comeback. Only Christian mentioned the possibility of doing resistance training (weight lifting) based recovery, and Sissel, who is recovering from surgery, is experimenting putting various loads on her wrists via calisthenics (bodyweight exercise). None of the candidates reported being physically very active as well but none of them live a sedentary lifestyle either.
3. THE CORRESPONDENTS
According to Brandfonbrener and her colleagues’ study done in 2009 on incoming students to a Midwestern university in America, 79% of the students and all of the incoming percussion students had experienced playing related pain over a four-year period (Brandfonbrener, 2009). Almost every percussionist I have met, has dealt with some kind of injury during their career, therefore finding correspondents for my of project was not very hard.
3.1 About the correspondents
All correspondents had received private percussion lessons for a minimum of 7 years and a maximum of 17 years with the average being 13.8 years. Their age range is from 18 to 36 with the average age of 25.3 years old. Out of the six subjects, five were male and one female. The interviews were videotaped for documentation and transcribed word for word. All correspondents gave consent for the use of their information in this research. Names of each one have been changed to give them anonymity.
Candidates were not chosen based on age, gender or nationality. The criteria for qualifying for the interviews were extensive percussion studies including private lessons, an injury which made them unable to play and having sought out professional help. Interviews were conducted from March to May 2020.
Arnold is a student in his final year of undergraduate studies. He has been dealing with injuries since November 2018. Arnold first noticed symptoms when he was preparing a solo piece “She who sleeps with a small blanket” by Kevin Volans for a large solo recital. Arnold had recently played a big solo concert with great success and was eager to play his next concert. Volan’s piece has a challenging double-stroke pattern which forces some quick pronation and supination of the forearm. Arnold noticed some soreness in his arm while working on this pattern. He got worried when the soreness did not go away after taking time off from practicing.
Arnold’s initial symptoms were pain and stiffness around the wrist and forearm on the flexor side in supination and proration which gradually got worse the more he played on a daily basis. After five months he returned to normal practicing but had to slowly rebuild strength and endurance in his hands.
During the time he was recovering, Arnold could still notice that pronation and supination, which is a common motion in four mallet playing, causing him mild pain. A year later he re-injured himself and had to take four months off again.
Arnold has not regained his former strength but has been able to balance his practice schedule with his physical abilities.
Arnold’s condition appears to be some sort of a tendon issue, most likely a tendonitis. It is important to remember about musicians that taking long time off is never what they want to hear, doctor Ingólfsson (2020) told me. Tendons, while having the ability to heal, do it very slowly and if they are not nurtured ideally for recovery, it can take up to nine months, assuming the activity does not aggravate the condition. “Pain of the forearm or especially if it relates to the movement, is very likely to be tendonitis, especially when it is associated with a specific movement” (Ingólfsson, 2020).
Christian is a percussion student about to enter the final year of his bachelor studies. During his education he has occasionally felt small pains in his hands. This is normal occurence and has been widely researched that developing muscles and endurance cause small inflammations which can lead to pain. (Proske, 2005).
In January of 2020, Christian returned from a two-week playing break to prepare for a big audition. The list for this audition had marimba repertoire in it which made him increase his daily practice time on marimba. He started to feel “strange” in his arm after about two weeks of practice, which he characterized as stiffness and tingling in his fingers with decreased stamina.
Christian’s initial reaction was to reduce his practice time but after five days he stopped practicing completely and decided to see a physical therapist. The physical therapist told him that he had an entrapment in his wrist restricting his mobility and attempted to free the wrist. When the pain didn’t go away and he got more anxious about this, Christian saw a second physical therapist. The second physical therapist told him that his pectoral muscles, biceps brachii and forearm extensors were tight and restricting his mobility, therefore leading to pain and stiffness.
Regardless of his unclear diagnosis, he is still trying to recover. Christian has been resting for about three months with less than 30 minutes of daily practice. He has not been able to fully apply himself in the practice room for almost four months now. Even though his physical state is improving, Christians recovery will be a long process.
Robert is a 29 year old professional percussionist working in a national opera orchestra. Robert has dealt with a tendonitis in his wrist for a few years now and has had two episodes which have made him unable to play percussion.
Roberts first injury occurred during his bachelor studies in 2013. Robert was preparing a marimba concerto that required a lot of loud fortissimo playing in the high register. Robert only had soft mallets, therefore he had to use a lot of force to get enough volume out of the instrument.
His initial symptoms were just soreness but as it evolved, he lost power and developed pain when flexing and extending his wrist. Robert was fortunate to get hurt close to the Christmas break, so he was able to take a break from practicing without losing too much time at school. He could return to the practice room after six weaks and was back to normal about two weeks later.
Robert got injured again in 2018 but this time it was not really about his playing as much as about managing his body and his routines which led to inflammation. While preparing for an exam at school, he was doing short intense practice session to learn scales and etudes. After sleeping poorly and a day of intense practice, he injured his wrist the same way as before. He took four weeks off and was able to manage himself back to normal in around two or three weeks.
Alex is the principal percussionist a professional symphony orchestra for eight years. Alex started feeling symptoms in his arms when he was getting back into shape for the new season with his orchestra in August 2018. He felt tiredness and mild pain in his forearm but did not pay too much attention to it when the season opened. After the season began, the pain in his hand would not cease and his hand felt very restricted.
He sought help from a physical therapist who told him that he needed to take time off right away or he would come back to her in a month with worse symptoms.
Alex ended up taking around one month off from work but during that time his pain developed and his gripping strength diminished. “I could barely hold a book or cut vegetables”, Alex (2020) said. After his time off, he returned to work and practice slowly, foc using on playing physically less demanding parts.
After about six months of building back up, Alex felt like he was back to his normal shape even though it was a very tedious and slow recovery process.
Kato is a percussion student in his final year of studies who has dealt with a lot of pains related to his hands. A genetic arthritis runs in Kato’s family and therefore he has always been aware of his body and did monitor his practice times very carefully before starting university. After starting at the university, he became less and less careful. Eventually he got tendonitis in his right wrist.
His initial symptoms were lack of mobility in the wrist combined some tenderness. His pain got worse over time and would also occur when he was not playing. Kato was forced to take time off for almost two months and was able to make full recovery.
Kato played in the navy band from 2017 - 2018 and got tendonitis again in January of 2018. The workload in the band was quite heavy and the pain had been growing slowly for a while from the beginning of 2018. Shortly before he was forced to take a break, he was using so much pain relieving gel that it was making him feel light-headed. Eventually he had to take six weeks off and started to build his strength back very slowly. Kato’s symptoms were the same both times and he says he has gotten small versions of wrist tendonitis in recent times but due to his previous experience, he has been able to deal with it. He also says that he almost always feels it and has had to monitor his hand carefully for the last four years.
Sissel is an 18 year old percussionist graduating from music high school. She has been playing percussion for seven years. Sissel aggravated her wrist after carrying a lot of heavy equipment for a mock exam in the spring of 2018. Previosly she had some wrist pain but it got worse following this incident.
During a brass band competition few months later, her wrist started hurting so severely she could barely play. Sissel’s symptoms were pain in the bones, inabilityto flex the right wrist without pain. Her grip strength also diminished. She visited a doctor who told her she was probably just practicing too much and she should not worry.
When the pain did not go away, she went to a specialist who found a huge bubble on her wrist. Sissel was diagnosed with a ganglion cyst which was surgically removed soon after.
The surgery had quite severe repercussion because she had to change her main instrument at school and has not been able to play percussion for 3 months since her surgery. Sissel is recovering steadily and is expected to make full recovery in another 3 months or so.