1. Common Pain Syndromes (with Anatomy!)

2. Ackermann B, Driscoll T, Kenny D. Musculoskeletal Pain and Injury in Professional Orchestral Musicians in Australia. Med Probl Perform Art 2012;27:181-187

4. Neck Thoracic Outlet Syndrome – Compression or stretching of the neurovascular structures of the neck leading into the arm Cause pain, tingling, numbness, heavy sensation, cold to the touch, or cold sensation Can affect any part of the lateral neck or arm

7. Participants who reported neck pain after playing were put into the pain group Park K, Kwon O, Ha S, Kim S, Choi H, Weon J. Comparison of Electromyographic Activity and Range of Neck Motion in Violin Students with and without Neck Pain During Playing. Med Probl of Perform Art. 2012;17:188-192

8. Shoulder Impingement Syndrome – Compression of the structures in the subacromial space Biceps tendon Supraspinatus tendon Subacromial Bursae – Compression of this space is significantly increased when the arm is elevated

10. Elbow, Wrist, Hand & Fingers Medial Epicondylitis – Aggravation of the wrist / finger flexors Lateral Epicondylitis – Aggravation of the wrist / finger extensors Carpel Tunnel Syndrome – Impingement of medial nerve in the wrist Finger Pathologies

11. Flexors of the Wrist, Hand, and Fingers Palmar wrist, hand, fingers Medial epicondyle of the elbow

12. Flexors of the Wrist, Hand, and Fingers When the wrist is flexed, there is a: – Decrease in finger flexor muscle force – Decrease in precision and dexterity – Due to a phenomenon called active insufficiency of the flexors and passive insufficiency of the antagonists (extensor muscles) Grandjean E: Manual de Ergonomia: Adaptando o Trabalho ao Homem. Proto Alegre: Artes Medicas; 1998.

13. Extensors of the Wrist, Hand, and Fingers Dorsal wrist, hand, fingers Lateral epicondyle of the elbow

14. Carpel Tunnel Syndrome

16. Finger Pathologies

17. Low Back Pain Almost always related to postural asymmetries © Postural Restoration Institute

18. Brachial Chain (BC): Anterior-Lateral Intercostals, Deltoid-Pectoral Muscle, Sibson’s Fascia, Triangularis Sterni, Sternocleidomastoid, Scaleni, Diaphragm Anterior Interior Chain (AIC): Diaphragm, Iliacus, Psoas, TFL, Vastus Lateralis, Biceps Femoris The Diaphragm is the overlap between the two chains

19. © Postural Restoration Institute

20. Physical Preparation

21. Instrument and Environment Analysis Making sure the instrument is placed in an ergonomically correct position – Support stands, straps, athletic taping, orthotic device Correct seating Lighting Placement of music stand

22. Recommendations

23. Recommendations using everything we now know Proper outside-of-music activity is important for increased performance ability and injury reduction Reduce stress – Let pain be your guide Appropriate warm-up is essential – Focusing on the problem areas discussed in this lecture

24. Warm-up Finger flexion and extension Arm and trunk range of motion Stretching – From fingers to low back, every muscle group has the potential to cause a pain syndrome Simple music More complex music

25. When you Feel Pain… “PRICED” – PProtect – RRest – IIce – CCompression – EElevation – DDiagnosis

26. Performing Arts Medicine at Appalachian State

27. Performing Arts Medicine At Appalachian State University: – College of Health Sciences – Department of Theatre & Dance – Athletics Department – Hayes School of Music Staff with performing arts medicine education – Program implementation – Research

29. PerformingArtsMedicine.appstate.edu

30. Questions?