All
music involves the hands except for voice. Even the humble
harmonica uses the hands to side shift the instrument.
The hands are my area of particular expertise. Over 26
years of experience with student musician’s problems
I have seen a great variety of problems which both directly
and indirectly affect high-level performance. Conditions
arising from trauma such as sprains and fractures are
common. Carpal bone displacements and adhesions with
consequent tendinous irritations are often observed in
such cases. Technique habits which may have persisted
since childhood which were once useful but are now superfluous,
can continue to predicate style and production.
Working
with many seasoned professionals has also extended my
experience. With each new patient comes a new variation
of signs and symptoms, each one an education in itself.
I
too have suffered many wrist injuries as a result of
the hands-on work that I do. Intense guitar playing and ‘mousing’ my
PC for hours creating websites don’t help either.
However, such episodes have served to edify me with regard
to the general and specific nature of finger, wrist,
arm, shoulder, neck and upper ribcage interactions. Said
interactions manifest via lines of tension, nerve pain,
pins and needles, muscle ache and joint ache by virtue
of a sequence of shortening of adjacent structures in
response to habit and irritation.
I
have found that the majority of symptoms arise
from the deep muscles, hwever, often the tendons of the
superficial muscles are irritated as they pass over areas
where the carpal bones are misaligned and or inflammed.
When
the deep ‘stabilising’ muscles of the forearm
become hypertonic or overly tense they lose Oxygen and
rapidly tire, causing pain. This reaction is more likely
than with the superficial layers due to the type
of reflex tone setting mechanism and because of restriction
to their expansion. The girth of the deep muscles is
more tightly constrained than the superficial muscles.
This physical constraint to expansion is due to the membranous
sheath which envelopes every skeletal muscle of the body.
Described as a stout membrane, the epimysium is a layer
of connective tissue which ensheaths the entire muscle.
It is composed of dense connective tissue and is continuous
with the fascia of adjacent muscles and the internal
connective tissue wrappings within the muscles.
The
density of this sheath varies from deep to superficial
muscle layers. Thus, when the deep muscles expand through
constant and also unique occasions of overuse they become
constrained by the limits of the dense membranes enveloping
them. When this state of hypertonus has persisted for
some time the nervous system registers the increased
tone as normal and automatically maintains the tension
even though it is no longer appropriate. Pain will be
generally perceived at the anchor points of the muscles
and their tendons i.e. the elbow and upper forearm, and
the fingers and wrist.
Often
I have observed that the superficial layer is weak and
flaccid whilst the deep layers are very dense and shortened.
Observation of top professional pianists demonstrates
that the relaxed, flowing approach to playing, honed
by many years of skill acquisition and the relative absence
of poor postural and technique habits plus familiarity
with their own repertoire serves to maximise their performance
abilities.
However,
even these performers can be struck down by injuries
such as falls on to the hand, gardening, decorating,
writing, carrying heavy bags, and a host of other trauma.
Go
to my site at www.anatomy.musician.org.uk to see 3D interative
anatomy and a few case histories specific to musicians.
I
am able, by virtue of specialised and unique hands-on
techniques that I call ‘Myo-articulation’,
to reverse deep tension patterns quite swiftly. If there
is carpal bone derangement present, I can very specifically
locate and ‘undo’ adhesions and re-align
these delicate little bones of the wrist. I will ‘track’ the
tension patterns along the arm and identify shoulder,
ribcage and neck involvement. These I will then release
using a variety of techniques such as articulation, massage
and manipulation where necessary.
It
is even possible to identify, by palpating the tensions
in individual muscles, specific playing related patterns
of overuse such as the little finger in trills on the
violin, over- gripping and over-flexing in the bowing
hand and much more.
Working
with the students has often involved dialogue with their
tutors. This has enabled me to get objective feedback
about ‘cases’ thus further enhancing my development
in this area.
I
hope to disseminate my knowledge and techniques to the music
profession in light of the profound and distressing effects
that such physical problems can have on very gifted individuals
and in light of my successes in treating such problems.
