performing arts medicine msc”ιαλέξεις 2019/ht...development of a specific exercise...
TRANSCRIPT
PERFORMING ARTS MEDICINE
MSCDIVISION OF SURGERY amp
INTERVENTIONAL SCIENCEUNIVERSITY COLLEGE LONDON
wwwuclacuksurgerycoursesmsc-performing-arts-medicine
Collaborations
bull Institute of Sport
Exercise and Health
bull British Association for Performing Arts Medicine
bull Royal National
Nose Ear amp Throat Hospital
Collaborations
bull English National Opera
bull Royal College of Music
bull National Centre
for Circus Arts
Collaborations
bull Royal Ballet
bull English National Ballet
bull British Institute
of Modern Music
Structure
bull Postgraduate Certificate (PG Cert) ndash 4 modules ndash 60 credits
bull Postgraduate Diploma (PG Dip) - 8 modules ndash 120 credits
bull Masters (MSc) ndash 8+1 modules ndash 180 credits
bull Full-time 1 year
bull Part-time 2 years
bull September start
bull Distance Learning
bull Short Courses
Κατηγοριες Μουσικων Οργανων και Μυοσκελετικες Αναφορες
bull Συντομη περιγραφη των κυριων μουσικων οργανων και των απαιτησεων τους
bull Οι μουσικοι της ορχηστρας η τοποθετηση τους και ο μαεστρος
bull Οι ιδιαιτεροτητες των μουσικων ποπ και ροκ
bull Αναφορα στις εργονομικες και φυσιολογικες διαδικασιες που επηρεαζουν και διαμορφωνουν τις μυοσκελετικες προσαρμογες των μουσικων
bull REFERENCES
bull BIRD HA (2016) Performing Arts Medicine in Clinical Practice 1st ed London Springer International Publishing
bull RAMELLA M et al (2014) Postural Disorders in Conservatory Students The Diesis Project Medical Problems of Performing Artists 29(1) pp 19
Ergonomics
bull Instrumentalists come in all sorts of shapes and sizes
bull Instruments come in specific shapes and sizes
bull So instrumentalists have to adapt to their instruments often playing them for long periods in un-ergonomic positions
SYMMETRY
bull SYMMETRICAL - WoodwindPICCOLO FLUTE OBOE CLARINET BASSOON
- Keyboards PIANO ORGAN KEYBOARDS
bull PARTIAL SYMMETRY - Brass CORNET TRUMPET TROMBONE TUBASAXOPHONE
bull ASYMMETRIC - Strings
VIOLIN VIOLA CELLO DOUBLE BASS GUITAR HARP
- FLUTE
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Collaborations
bull Institute of Sport
Exercise and Health
bull British Association for Performing Arts Medicine
bull Royal National
Nose Ear amp Throat Hospital
Collaborations
bull English National Opera
bull Royal College of Music
bull National Centre
for Circus Arts
Collaborations
bull Royal Ballet
bull English National Ballet
bull British Institute
of Modern Music
Structure
bull Postgraduate Certificate (PG Cert) ndash 4 modules ndash 60 credits
bull Postgraduate Diploma (PG Dip) - 8 modules ndash 120 credits
bull Masters (MSc) ndash 8+1 modules ndash 180 credits
bull Full-time 1 year
bull Part-time 2 years
bull September start
bull Distance Learning
bull Short Courses
Κατηγοριες Μουσικων Οργανων και Μυοσκελετικες Αναφορες
bull Συντομη περιγραφη των κυριων μουσικων οργανων και των απαιτησεων τους
bull Οι μουσικοι της ορχηστρας η τοποθετηση τους και ο μαεστρος
bull Οι ιδιαιτεροτητες των μουσικων ποπ και ροκ
bull Αναφορα στις εργονομικες και φυσιολογικες διαδικασιες που επηρεαζουν και διαμορφωνουν τις μυοσκελετικες προσαρμογες των μουσικων
bull REFERENCES
bull BIRD HA (2016) Performing Arts Medicine in Clinical Practice 1st ed London Springer International Publishing
bull RAMELLA M et al (2014) Postural Disorders in Conservatory Students The Diesis Project Medical Problems of Performing Artists 29(1) pp 19
Ergonomics
bull Instrumentalists come in all sorts of shapes and sizes
bull Instruments come in specific shapes and sizes
bull So instrumentalists have to adapt to their instruments often playing them for long periods in un-ergonomic positions
SYMMETRY
bull SYMMETRICAL - WoodwindPICCOLO FLUTE OBOE CLARINET BASSOON
- Keyboards PIANO ORGAN KEYBOARDS
bull PARTIAL SYMMETRY - Brass CORNET TRUMPET TROMBONE TUBASAXOPHONE
bull ASYMMETRIC - Strings
VIOLIN VIOLA CELLO DOUBLE BASS GUITAR HARP
- FLUTE
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Collaborations
bull English National Opera
bull Royal College of Music
bull National Centre
for Circus Arts
Collaborations
bull Royal Ballet
bull English National Ballet
bull British Institute
of Modern Music
Structure
bull Postgraduate Certificate (PG Cert) ndash 4 modules ndash 60 credits
bull Postgraduate Diploma (PG Dip) - 8 modules ndash 120 credits
bull Masters (MSc) ndash 8+1 modules ndash 180 credits
bull Full-time 1 year
bull Part-time 2 years
bull September start
bull Distance Learning
bull Short Courses
Κατηγοριες Μουσικων Οργανων και Μυοσκελετικες Αναφορες
bull Συντομη περιγραφη των κυριων μουσικων οργανων και των απαιτησεων τους
bull Οι μουσικοι της ορχηστρας η τοποθετηση τους και ο μαεστρος
bull Οι ιδιαιτεροτητες των μουσικων ποπ και ροκ
bull Αναφορα στις εργονομικες και φυσιολογικες διαδικασιες που επηρεαζουν και διαμορφωνουν τις μυοσκελετικες προσαρμογες των μουσικων
bull REFERENCES
bull BIRD HA (2016) Performing Arts Medicine in Clinical Practice 1st ed London Springer International Publishing
bull RAMELLA M et al (2014) Postural Disorders in Conservatory Students The Diesis Project Medical Problems of Performing Artists 29(1) pp 19
Ergonomics
bull Instrumentalists come in all sorts of shapes and sizes
bull Instruments come in specific shapes and sizes
bull So instrumentalists have to adapt to their instruments often playing them for long periods in un-ergonomic positions
SYMMETRY
bull SYMMETRICAL - WoodwindPICCOLO FLUTE OBOE CLARINET BASSOON
- Keyboards PIANO ORGAN KEYBOARDS
bull PARTIAL SYMMETRY - Brass CORNET TRUMPET TROMBONE TUBASAXOPHONE
bull ASYMMETRIC - Strings
VIOLIN VIOLA CELLO DOUBLE BASS GUITAR HARP
- FLUTE
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Collaborations
bull Royal Ballet
bull English National Ballet
bull British Institute
of Modern Music
Structure
bull Postgraduate Certificate (PG Cert) ndash 4 modules ndash 60 credits
bull Postgraduate Diploma (PG Dip) - 8 modules ndash 120 credits
bull Masters (MSc) ndash 8+1 modules ndash 180 credits
bull Full-time 1 year
bull Part-time 2 years
bull September start
bull Distance Learning
bull Short Courses
Κατηγοριες Μουσικων Οργανων και Μυοσκελετικες Αναφορες
bull Συντομη περιγραφη των κυριων μουσικων οργανων και των απαιτησεων τους
bull Οι μουσικοι της ορχηστρας η τοποθετηση τους και ο μαεστρος
bull Οι ιδιαιτεροτητες των μουσικων ποπ και ροκ
bull Αναφορα στις εργονομικες και φυσιολογικες διαδικασιες που επηρεαζουν και διαμορφωνουν τις μυοσκελετικες προσαρμογες των μουσικων
bull REFERENCES
bull BIRD HA (2016) Performing Arts Medicine in Clinical Practice 1st ed London Springer International Publishing
bull RAMELLA M et al (2014) Postural Disorders in Conservatory Students The Diesis Project Medical Problems of Performing Artists 29(1) pp 19
Ergonomics
bull Instrumentalists come in all sorts of shapes and sizes
bull Instruments come in specific shapes and sizes
bull So instrumentalists have to adapt to their instruments often playing them for long periods in un-ergonomic positions
SYMMETRY
bull SYMMETRICAL - WoodwindPICCOLO FLUTE OBOE CLARINET BASSOON
- Keyboards PIANO ORGAN KEYBOARDS
bull PARTIAL SYMMETRY - Brass CORNET TRUMPET TROMBONE TUBASAXOPHONE
bull ASYMMETRIC - Strings
VIOLIN VIOLA CELLO DOUBLE BASS GUITAR HARP
- FLUTE
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Structure
bull Postgraduate Certificate (PG Cert) ndash 4 modules ndash 60 credits
bull Postgraduate Diploma (PG Dip) - 8 modules ndash 120 credits
bull Masters (MSc) ndash 8+1 modules ndash 180 credits
bull Full-time 1 year
bull Part-time 2 years
bull September start
bull Distance Learning
bull Short Courses
Κατηγοριες Μουσικων Οργανων και Μυοσκελετικες Αναφορες
bull Συντομη περιγραφη των κυριων μουσικων οργανων και των απαιτησεων τους
bull Οι μουσικοι της ορχηστρας η τοποθετηση τους και ο μαεστρος
bull Οι ιδιαιτεροτητες των μουσικων ποπ και ροκ
bull Αναφορα στις εργονομικες και φυσιολογικες διαδικασιες που επηρεαζουν και διαμορφωνουν τις μυοσκελετικες προσαρμογες των μουσικων
bull REFERENCES
bull BIRD HA (2016) Performing Arts Medicine in Clinical Practice 1st ed London Springer International Publishing
bull RAMELLA M et al (2014) Postural Disorders in Conservatory Students The Diesis Project Medical Problems of Performing Artists 29(1) pp 19
Ergonomics
bull Instrumentalists come in all sorts of shapes and sizes
bull Instruments come in specific shapes and sizes
bull So instrumentalists have to adapt to their instruments often playing them for long periods in un-ergonomic positions
SYMMETRY
bull SYMMETRICAL - WoodwindPICCOLO FLUTE OBOE CLARINET BASSOON
- Keyboards PIANO ORGAN KEYBOARDS
bull PARTIAL SYMMETRY - Brass CORNET TRUMPET TROMBONE TUBASAXOPHONE
bull ASYMMETRIC - Strings
VIOLIN VIOLA CELLO DOUBLE BASS GUITAR HARP
- FLUTE
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Κατηγοριες Μουσικων Οργανων και Μυοσκελετικες Αναφορες
bull Συντομη περιγραφη των κυριων μουσικων οργανων και των απαιτησεων τους
bull Οι μουσικοι της ορχηστρας η τοποθετηση τους και ο μαεστρος
bull Οι ιδιαιτεροτητες των μουσικων ποπ και ροκ
bull Αναφορα στις εργονομικες και φυσιολογικες διαδικασιες που επηρεαζουν και διαμορφωνουν τις μυοσκελετικες προσαρμογες των μουσικων
bull REFERENCES
bull BIRD HA (2016) Performing Arts Medicine in Clinical Practice 1st ed London Springer International Publishing
bull RAMELLA M et al (2014) Postural Disorders in Conservatory Students The Diesis Project Medical Problems of Performing Artists 29(1) pp 19
Ergonomics
bull Instrumentalists come in all sorts of shapes and sizes
bull Instruments come in specific shapes and sizes
bull So instrumentalists have to adapt to their instruments often playing them for long periods in un-ergonomic positions
SYMMETRY
bull SYMMETRICAL - WoodwindPICCOLO FLUTE OBOE CLARINET BASSOON
- Keyboards PIANO ORGAN KEYBOARDS
bull PARTIAL SYMMETRY - Brass CORNET TRUMPET TROMBONE TUBASAXOPHONE
bull ASYMMETRIC - Strings
VIOLIN VIOLA CELLO DOUBLE BASS GUITAR HARP
- FLUTE
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Ergonomics
bull Instrumentalists come in all sorts of shapes and sizes
bull Instruments come in specific shapes and sizes
bull So instrumentalists have to adapt to their instruments often playing them for long periods in un-ergonomic positions
SYMMETRY
bull SYMMETRICAL - WoodwindPICCOLO FLUTE OBOE CLARINET BASSOON
- Keyboards PIANO ORGAN KEYBOARDS
bull PARTIAL SYMMETRY - Brass CORNET TRUMPET TROMBONE TUBASAXOPHONE
bull ASYMMETRIC - Strings
VIOLIN VIOLA CELLO DOUBLE BASS GUITAR HARP
- FLUTE
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
SYMMETRY
bull SYMMETRICAL - WoodwindPICCOLO FLUTE OBOE CLARINET BASSOON
- Keyboards PIANO ORGAN KEYBOARDS
bull PARTIAL SYMMETRY - Brass CORNET TRUMPET TROMBONE TUBASAXOPHONE
bull ASYMMETRIC - Strings
VIOLIN VIOLA CELLO DOUBLE BASS GUITAR HARP
- FLUTE
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
BODY ADJUSTMENTSThe Clarinettist
Technical problems (Mcilwain 2010)
1Excessive pressure on finger pads
2Poor wrist alignment
3Shoulder tension
4Excessive movement whilst playing
5Tense and locked fingers Long Keys
Short Keys
Thumb of Right Hand
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Posture
bull Sitting or standing
bull Carrying
bull Important factorsbull Muscle strength
bull Flexibility
bull Stamina and endurance
bull Body Awareness
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Violin Hold
Contact points
1 Jawchin
2 ClavicleShoulder
3 Base of first finger
4 Thumb
The support muscles tire out first
Posture suffers
Compensatory postures amp movement lead to injury
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Violin injuries
Asymmetrical posture = muscular imbalances
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Posture-Related Injuries
Guitar size shape weight
Asymmetric
Sitting or Standing positions
Strap
Hand Size
Grip
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
The Harp
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
brass instruments
bull Shape size and weight
bull Trombone
bull Chest and diaphragm
bull Embouchure mouth and cheeks
bull Fine control of the tongue
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
PERCUSSION
bull Orchestral
bull Jazz and Pop
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
keyboards
bull Action ndash FINGER WORK amp MUSCLE BALANCE
bull Regulation - CONTROL
bull Height of Piano Stool - POSTURE
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
bull Heavy workload on upper limbsbull Brain activated to control
complex motion
Piano demands
superhuman technique
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Ideal posture
times Left seated too close- Neck flexion- shoulder - elbow bending
Right correct
times Left seated too low- elbow bending
- too low wrist
Right correct
times
(Guptill C and Zaza C 2010)
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
REPERTOIRE
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
THE ROCKERSLow back
Right wrist and shoulder
Finger trauma Pronation injury
Lateralmedial epidondylitis
Headneckthorax
Knee Ankle
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
bull Wrist problems
bull Tendinopathies
bull Shoulder Tension
bull Low back amp Neck
bull Kneeankle
Keyboard ndash Keyboards
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
The bass and guitar players
bull Strap
bull Instrument position
bull Mic position
bull Size and weight of instrument
bull Cables ndash risk of falling
bull Stage size
bull + everything else
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
ldquoHead and neck injury risks in heavy metal head bangers stuck between rock and a hard bassrdquo BMJ (2008)
ldquo To minimize the risk of head and neck injury head bangers should
bull decrease their range of head and neck motion
bull head bang to slower tempo songs by replacing heavy metal with adult oriented rock
bull only head bang to every second beat
bull use personal protective equipment ldquo
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
lsquoΜυοσκελετικες Διαταραχες του Ανω Ακρου
των Μουσικωνrsquo
bull Το ανω ακρο και η εννοια της κινητικης και νευρομυικης αλυσιδας απο τον κορμο μεχρι
τα δακτυλα
bull Οι διαταραχες που παρουσιαζονται στο ανω ακρο του μουσικου και πως προσεγγιζουμε
την δαγνωση τους
REFERENCES
TUBIANA R and CHAMAGNE P (1988) Functional Anatomy of the Hand Medical Problems of Performing Artists 3(3)
pp 83
TUBIANA R (1988) Movements of the Fingers Medical Problems of Performing Artists 3(4) pp 123
TUBIANA R et al (1989) Fundamental Positions for Instrumental Musicians Medical Problems of Performing Artists4(2)
pp 73
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
What pain
medical condition social psychological issues posture technique practice repertoire habits
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Where is the painHow does the pain behave
Back
Neck
Hand
Wrist
Elbow
Shoulder
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
WHEN WE KNOW THE MEDICAL CONDITION
SPECIFIC PAIN
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Carpal Tunnel Syndrome
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
De Quervainrsquos Tenosynovitis
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Dupuytrenrsquos Disease
NO PAINnodulesrarr thickeningrarr contracture
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Trigger Finger Thumbmaybe painlsquotriggeringrsquo
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Ganglion Cystpain amp size vary and exacerbated by repetitive movements
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Osteo-arthritis
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
WHEN WE CANNOT FIND A MEDICAL
CONDITIONNON-SPECIFIC PAIN
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Letrsquos see how you playhellip
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Technique
WE NEED
bull Flexible bow-hand fingers
bull Refine large movements
bull Enough energy on string
Tension in the right hand is impeding bowing ability
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Healthy Bow HoldbullNo gripping
bullFingers curved
bullRelaxed manner
bullNo stiff joints
bullSoft palm
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
POSTURE
bull Position of least strain
bull Balance
Risky postures
NeckTorso
Shoulders
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Chin rest amp Shoulder pad
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Shoulder down
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
bull Keep head level
bull Look directly forward
bull Adjust whole body
Music StandampThe Conductor
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
POSTURE
bull Keep natural curves
bull Shoulders down
The Lower Back
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Holding the Instrument
bull Hold with ease
bull Natural mechanics
bull Stability from Scapula
Tension
Biomechanics
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Wrist amp Hand
bull Watch them play
Tension
Biomechanics
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
BOWING
bull Movement starts in Upper Back
bull Shoulder joint is the pivot
bull Elbow wrist and fingers passive motions
bull Free to move
bull Minimum energy
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Can Physical Tension cause PainYES
bullCo-Contraction of muscles
bullExcess Contraction of muscles
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Excess Contraction
bull Muscles need blood
bull If contracted too much or for too long darr blood supply
bull darr blood supply = cramp fatigue injury
Muscles need to relax to uarr blood supply
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Just the hands
or the whole body
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Muscles are made up of cells (fibres)
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Cells need O2 to work
They take O2 from the bloodWhen the work is done they release CO2 to the blood
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Blood supply of the arm
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
The muscles that move the forearm are in the upper armagonist ne antagonisttension ne release
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
The muscles that move the fingers and the wrist are in the forearm
agonist ne antagonisttension ne release
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Lumbricals rarr bend the knuckles with straight fingers
Interossei rarr spread out the fingers
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
How can we help
bull Relaxation Methods
bull Breathing Exercises
bull Psychological Support
bull Muscle Activity Monitoring amp Biofeedback
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Muscle Relaxation
All muscle groups have to learn to relax
bull Hand
bull Forearm
bull Arm
bull Neck amp Head
bull Lower Back
bull Pelvis amp Legs
DURING PRACTICEDURING PERFORMANCE
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Breathing
bullBreathing rhythm and pattern has to be learned
practiced and incorporated
in the performance
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Shoulder Bladebull The scapula is in the correct position and fixed by supporting muscles
bull The rotation of the inferior corner of the scapula is essential for the natural movement of the shoulder joint
bull If the scapula wings off andor tilts forward the rotating movement is not possible the shoulder joint and the TOS close up and the muscles in the upper arm and the neck and shoulder area are overloaded
bull Incorrect position of the scapula may cause problems such as
Diffuse Pain Fatigue Shaking Numbness Weakness Poor Control
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Pianistsrsquo hands or pianistsrsquo shoulders
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
You have two shoulder blades
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Scapula motion and fixation
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Scapula and Clavicle Motion and Fixation
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Kinematic Chaina biomechanically efficient pattern of motion
Sequence of Muscular Events ndash XL L M S XS
The musician needs to know
which muscles to engage
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Stretch
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Strengthen
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Discipline of Biomedical Science Sydney Medical School
bull Inj Prev 201319257-263
bullDevelopment of a specific exercise programme for professional orchestral musicians
bull Cliffton Chan1 Tim Driscoll2 Bronwen Ackermann1
bull Using available evidence on exercise prescription in collaboration with clinical consensus and current best practice a specific exercise programme was developed to prevent andor reduce occupational injuries in professional orchestral musicians
bull Shoulder series
bull A progressive series of scapular stability and rotator cuff exercises were included focusing on restoring shoulder muscle balance and movement control This progressed to stages that added resistance and increased the functional context of the exercises into instrumental performance biomechanical patterning
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
College of the Arts University of South Florida
bull Med Probl Perform Art 2012 Jun27(2)85-94
bull Intervention program in college instrumental musicians with kinematics analysis of cello and flute playing a combined program of yogic breathing and muscle strengthening-flexibility exercises
bull Lee SH1 Carey S Dubey R Matz R
bull College musicians encounter health risks not dissimilar to those of professional musicians Fifteen collegiate instrumental musicians participated in the intervention program of yogic-breathing and muscle-strengthening and flexibility exercises for 8 weeks Pre- and post-intervention data from the Health-Pain-Injury Inventory (HPI) and the Physical amp Musical-Performance Efficacy Assessment Survey (PME) were analyzed for the effects of the program on the musicians physical and musical-performance efficacy HPI results showed that the majority of our sample had healthy lifestyles and minimal pain and injuries but irregular eating and exercise habits The pre-intervention PME data showed a high level of musical efficacy (ie awareness of music technique tone and flow) but a low-level of physical efficacy (ie awareness of posture tension and movement flexibility) Post-intervention data showed that the program improved physical efficacy by increased awareness of posture and tension In 2 volunteer musicians kinematics motion analysis was conducted for exploratory purposes Our cellist played the scale using a larger range of motion (ROM) in rightshoulder flexion and abduction and slightly increased rotation while keeping decreased right elbow ROM after the intervention program The flutist shifted the body weight from one foot to the other more in the second playing post-intervention These changes can be attributed to the increased physical efficacy that allowed freedom to express musicality Findings from these case scenarios provide empirically based hypotheses for further study We share our experience so that others may use our model and instruments to develop studies with larger samples
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Royal Welsh College of Music and Drama Cardiffbull Work 201140(3)317-24 doi 103233WOR-2011-1238
bullPostural problems of the left shoulder in an orchestral trombonist
bull Price K1 Watson AH
bull Professional musicians require a disciplined and balanced regime of practise and performance to enable them to cope with the physical challenges of their chosen instrument and to reduce the risk of work- related injury If practise or performance strategies are suddenly changed permanent damage may occur even in a player with a mature well-established technique The trombone presents unique physical challenges which are heightened by recent developments in instrumental design as well as by orchestral working conditions This study presents the experiences of a professional orchestral trombonist who worked as a principal player in a UK orchestra until his performing career was cut short by a performance related injury His personal approach to practise is discussed in the context of the physical and professional challenges associated with contemporary orchestral practices The case study demonstrates the importance of considering the interplay between psychological and physical factors in the development and treatment of injury in musicians
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Bio Psycho Social
Wrong technique
darrFatiguecrampinjury
darrPain
darrPoor performance quality
darrPerformance Anxiety Career issues etc
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Musicianrsquos Focal DystonialdquoMuscular incoordination
or loss of voluntary motor control
of extensively trained movements
while a musician is playing the instrumentrdquo
(Altenmuller 2010)
bull NO PAIN
bull DYSTONIC POSTURE
bull TASK SPECIFIC
bull Career ending
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Rapid repetitive highly stereotypic movement can degrade corticalrepresentations of sensory information guiding fine motor hand movements (Byl et al 2005)
Musical practice in musicianrsquos dystonia leads to changes in cortical organisation that progress too far and begin to interfere with movement rather than assist (Rosenkranz et al 2005)
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Difficulty performing
Loss of control in fast passages
Slow movement of fingers
Weakness of the hand
Finger curling
Lack of precision
Irregularity
Past injuriesPsychological factors
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Neuroplasticity
Biofeedback Re-Training with sEMG(Neuroplastics)
Contact
bull wwwharatroulicom
bull haratrouligmailcom
bull haratrouliuclacuk
Thank you
Contact
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