by Dr. Marc Brodsky, Dr. John (Jack) Dowdle, Michele Lenes, and Joseph Corsello
Repetitive use injuries, particularly in the hands, are common for instrumentalists. Hand pain can be a result of many different ailments and musicians seeking treatment should be cautious.
Diagnoses should always be made by medical professionals. A team approach, especially consultation with specialists in musician injuries, can often provide the best treatment options. As pain can often have more than one cause, you should consider the possibility of following more than one treatment option.
A 69-year-old professional jazz drummer had pain, accompanied by numbness and tingling, in both hands and could not bend his fingers. He experienced moderate aching pain and difficulty holding his sticks both while practicing (two to three hours a day) and during two or three gigs a week. The pain was relieved by rest and breaks from drumming, though he sometimes woke up at night with a burning pain in both hands.
A rheumatologist originally diagnosed the problems as psoriatic arthritis, an autoimmune disease of the joints and skin. Powerful medications did not improve his condition and the pain proved debilitating. An MRI then revealed osteoarthritis resulting from overuse and general wear-and-tear of the joints.
An exam by an orthopedic hand specialist included observation of the musician playing the drums, which showed bone deformity and swelling around the middle joints of the fingers. Because the musician also had stiffness, numbness, and tingling the physician used Tinel’s test—tapping his wrists near the palm of his hands—and detected possible nerve compression in the carpal tunnel.
In the end, a hand specialist, occupational hand therapist, and integrative medicine pain management specialist were all enlisted as part of the drummer’s comprehensive treatment program.
The orthopedic hand specialist fitted the musician with hand splints for use at night, while the occupational therapist began hand therapy twice a week. Sessions included a paraffin wax dip and moist heat packs, hand massage to decrease swelling and improve mobility of the fingers, and gentle manipulation of the wrist, hands, and fingers. In addition, the therapist applied joint distractions (gentle pulling of the affected fingers). The drummer was taught hand-strengthening exercises to prevent pain recurrence.
The integrative medicine pain management specialist performed acupuncture once a week for four weeks, gradually reducing the treatment as the musician felt relief. Treatment focused on strategic points in the neck, arms, and hands. Acupuncture is not for everyone, however studies have shown it may restore resiliency by improving circulation and reducing muscle tension and inflammation around the placement of the needles. (Always consult with your primary care physician, and find a licensed practitioner with appropriate training and credentials.)
The integrative medicine physician recommended natural anti-inflammatories, namely ginger and curcumin (found in the Indian spice turmeric). In addition, topical capsaicin, a highly purified, heat-producing component in chili peppers, was applied to the top of the hands once a day. According to the clinical studies, capsaicin depletes the amount of substance P neurotransmitter that sends pain messages to the brain.
The Moeller Technique
The drummer modified his hand technique using the Moeller method. This technique uses gravity to do most of the work, emphasizing hand speed, power, and stick control, as well as the complete relaxation of the hand and arm muscles. Enlisting a strong downward whipping motion, the musician transitioned from pressing or gripping the drumstick predominately with the forefinger and thumb of the left hand down to the little finger. With this approach, the fulcrum is the back of the hand, allowing the other fingers to curl gently around the drumstick. This technique took pressure off the middle joints of the drummer’s hands, decreasing the risk of injury.
By employing the above treatments and techniques, the musician had dramatic relief of his hand pain, numbness, and tingling within four weeks. In addition, he had less swelling and was able to move his fingers with greater ease. Not only that, he experienced a higher degree of function, improved sound, and an overall sense of wellness.
Marc Brodsky, MD; John (Jack) Dowdle, MD; and Michele Lenes, OTR/L, are part of the Musicians’ Wellness Clinic in the Stamford Health System and are 2017 members in good standing of the Performing Arts Medicine Association (PAMA).