Chronic Pain and the Working Musician

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Severe chronic pain has left Joshua Trost, guitarist for The Feral Americans, unable to perform publicly. “My hand problem has prevented us from even doing much practicing,” Trost says. “We’re pretty much in limbo right now because of it.”

Trost, 41, has played guitar since he was 13 years old. Three years ago, with no blood or drama, he debilitated his hand while unscrewing a speaker from a cabinet. “I had an overuse injury I made worse,” Trost says. “I couldn’t even hold a toothbrush or turn a doorknob after it happened. I’m certain that had I not played guitar, I would not have experienced the degree of injury that I did.”

As many as 80% of musicians suffer from playing-related pain, according to research.

Trost has good reason to believe his chronic pain is related to guitar playing. As many as 80% of musicians suffer from playing-related pain, according to a survey of 330 incoming freshman at a school of music conducted by the medical journal “Medical Problems of Performing Artists,” in 2009. And playing-related pain can begin early for musicians of all stripes.

Dr. Daniel Ivankovich, orthopedic surgeon, blues musician and cofounder of One Patient Global Health Initiative, a nonprofit that has treated more than 100,000 uninsured or underinsured patients in Chicago, says musicians should be concerned about preventing repetitive strain injury in their hands, wrists, elbows, shoulders and back.

“Our whole philosophy, at least in my practice, is prevention,” says Ivankovich, who was recently named a 2015 Top 10 CNN Hero for his nonprofit work. “Repetitive and chronic wear-and-tear can absolutely be prevented in younger musicians by them just using their brain and thinking about how to save and preserve their body.”

Find a Fit

Most guitars were designed and built with right-handed men in mind, which may cause problems for lefties and those with smaller hands, Ivankovich says. So the first step in preventing injury is to make sure your instrument is fitted properly.

As a musician, you don’t just need to know your music, you need to know your physical requirements and limitations.

“There used to be very few choices, but these days there are actually lines of guitars that have been more fitted for women, making a body that is a little smaller, making a neck that is a little thinner and a little easier to play for small hands,” Ivankovich says, so find a guitar that fits you well and don’t settle for less. “If you’re struggling to play a guitar that doesn’t fit your hands, it is a setup for motion repetitive strain and associated injuries,” Ivankovich says. “As a musician, you don’t just need to know your music, you need to know your physical requirements and limitations. You need to be able express yourself in the most effortless kind of way,” he says.

Know Your Limits

Many musicians give themselves back and shoulder problems with poor posture while standing or sitting for hours while on stage, lugging around heavy equipment and practicing without breaks, Ivankovich explains, so knowing your physical limitations is important for avoiding injury.

In addition to making sure you are in good physical condition, he suggests doing warm-up and cool-down stretches; strengthening core muscles; taking frequent breaks and not sitting slumped over guitars slung between your knees. But, most of all, stop playing if you are in pain, Ivankovich says.

Trost reported that even before he injured his hand with the screwdriver, he endured hand pain and tingling after long hours of session work. “I was playing bass in a country cover band and their guitarist left. We were in the middle of recording sessions, so I got bumped up to play guitar,” he says. “When I was doing double duty, sometimes I would be playing for four hours two or three times a week. After those sessions, my left hand in particular would just be so sore,” he says.

Serves You Right to Suffer

After Trost injured his hand, he wore a brace for a month and did not play on the advice of an emergency room physician. After that month was over, he started playing again and developed a localized pain in the center of his palm, between the middle and ring fingers and the ring and pinkie area. In a perfect world, he would have seen a doctor. But like many musicians, playing gigs did not pay all the bills and Trost did not have health insurance. However, he has had some relief due to coverage via the Affordable Care Act.

Some guitar players will not see a doctor because they automatically assume a physician will recommend surgery, Ivankovich says. However, most respond well to therapy, scheduling and wearing a simple brace or splint to mitigate pain and can avoid going under the knife.

“With any sort of a hand or wrist symptoms, what we’ll do is try activity modification,” Ivankovich says. “Stop playing guitar for eight hours straight. Maybe break it up and play one hour at a time. If that doesn’t work, take a couple of days off and give it a rest. What we try to do is create a temporal history of when things are made worse, how they’re made better and then we’ll adjust the treatment plan accordingly.”

Meanwhile, as Trost waits for a diagnosis, he has adjusted how he plays. He has moved to lighter gauge strings and guitars with shorter scale necks, and the band has tuned down to lower string tension. “The message I’d leave with young musicians is that you may manage to secure your ideal guitars, amps and equipment, but they are all absolutely meaningless unless you can play them,” he says.

Flashback Friday: Chronic Pain and the Working Musician originally published at Reverb on Oct. 26, 2015

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