This article takes a look at musicians' injuries. For an expert perspective, I interviewed Dr. Sarah Mickeler, B.Mus., D.C. Dr. Mickeler is a former professional musician and a chiropractor who concentrates on musicians' injuries in her practice.

1) What led you to specialize in musicians' injuries?

I have a very personal connection to musician's injuries. I had trained as a classical clarinet player and it was during my undergrad that I started to have all sorts of problems from playing too much and with poor posture. Unfortunately, I was told, as many others are, that I should just play through the pain and that maybe it would get better! Of course, it didn't, and it eventually led to the demise of my career as a clarinetist, because I was totally unable to hold up my instrument. So, I decided to pick a new career that would help others musicians - and hopefully before they got to the point that I was at! Chiropractic appealed to me because of the whole health care paradigm that it embodies - as chiropractors, we diagnose and fix the cause, rather than masking the symptoms.

2) What is different about treating musicians than treating the general population?

Often, what I tell people who don't understand the specifics of musicians' injuries, is that "it takes one to know one". As a musician, it can be very difficult to explain to a physician or physiotherapist or even another chiropractor what the mechanics look like when you are playing your instrument. But when someone comes into my office and says that they play flute, or guitar, or tuba, or whatever, I know exactly what the physical component of playing their instrument involves. That is a very important first step.

Secondly, not only do you have to be able to have a good understanding of what playing that instrument involves, but you have to be able to see that person play. Even if someone tells me they play violin (I automatically think: "ok, so they will be leaning their head to the left and have right shoulder problems, etc..."), I am often shocked to see how over the years of playing they have contorted themselves into a little pretzel while they play!

So, on the first or second visit, all of my musicians bring in their instruments and I do a thorough playing analysis to see what it is that they're doing right and wrong. It could be that their posture is contributing to their injury. Or maybe there's something about the instrument that we could change; it might just need a minor adjustment in the thumb rest or a key positioning.

For instance, I have very small hands and found it difficult to reach some of the alternate fingering keys on my clarinet - so I had them sawed off and re-soldered on in a different direction so I could reach them.

Thirdly, it is important to recognize that there are some really common reasons for performance injuries. The most common ones are a change in repertoire, a change in the instrument (such as a new mouthpiece or something similar), a change in practice time or an upcoming recital. If we can pinpoint what it is that the performer has been doing differently lately to contribute to their injury, that helps immensely.

And lastly, it is so important to realize, especially for freelance artists, that you can't just tell them to take a muscle relaxant, and take a few weeks off. If these people took a few weeks off, they wouldn't have a roof over their head or food on the table. While it's occasionally absolutely imperative that a break be taken, most of the time I take a holistic approach to treating performers and change and fix what we can, within the obvious limitations of current gigs and upcoming events.

3) What's the most common injury that you see in your office?

In my office, there is a tie for the most common injury. The first is upper back/shoulder/neck pain - I lump these together because those terms can mean the same thing to a lot of people - often someone will come in and say that their shoulder hurts and point to the pain, but to me what they're pointing to is actually their upper back or lower neck. This one is often a function of poor posture or poor practice ergonomics. If we can figure out how to improve the overall posture and ergonomic situation then this tends to resolve quickly.

And the second most common injury is hand and arm pain. You would not believe how many people walk into my office with numb and tingly hands and fingers - which can be very scary if you're the one to experience it - to find out that the problem isn't actually their hands and fingers at all, but it's a little further up the arm and can be quite easily treated once properly diagnosed. Or they come in with tennis elbow - but they have never held a tennis racket in their life! In my office, I call tennis and golfer's elbow "musician's elbow" because it is a repetitive strain injury. It is really, really common and surprisingly easy to treat.

4) What can musicians do to prevent injury?

First of all, don't be a hero! There is just no reason to practice for hours on end without a break. Always remember to take a little break for every 30 minutes that you are playing. Secondly, don't play through pain. The pain signal is there to tell you that you are doing something wrong. Playing through it is not going to get you anywhere - other than in more pain and in worse shape down the road. Thirdly, be aware of your ergonomics. If you sit to play, does your chair fit you properly? In rehearsal, do you have to strain at all to see both the stand and the conductor? Are your arms contorted oddly in order to be able to play properly? This is not good. And lastly, seek the help of a professional who can not only help you with the injuries that you are currently dealing with, but can help you avoid future injury and optimize your overall performance.

You can find out more about Dr. Sarah Mickeler and her Toronto-based chiropractic practice concentrating on musicians' injuries at http://www.drsarah.ca.

To echo Sarah's advice, please pay attention to any pain signals your body is sending you! Admitting you're having a physical problem doesn't make you any less of a musician it means you're a very smart musician with years of playing ahead of you!!

This article was originally published on the Muses Muse Songwriter's Resource website (February 2005) http://www.musesmuse.com.

(c) Copyright Linda Dessau, 2005.