The Healthy Flute
by Sandra Cox, D.M.A.
Performance-related injuries. These three words can strike terror in any musician. What exactly is a performance-related injury? It is, simply, any injury that prohibits a musician from performing on an instrument. There is no limit on how much it interferes with playing, whether in performance or practice. It does not have to be so severe that it is incapacitating. This means that many times, we can continue to perform. Unfortunately, not having the injury evaluated means that we may be inflicting damage. This damage can continue, sometimes for a long time, and this could prevent performance.
In order to understand injuries, we need to understand how they are categorized. Injuries can occur in many different ways. Things like broken bones, and accidents are certainly problematic, and can cause multiple problems. But that is not what I am talking about. I am referring to injuries that occur because of what we do when we play, and how we accomplish the playing.
Broadly speaking, there are two main types of injuries. Many of the problems musicians have can be classified into one or the other. These two categories are Overuse Syndromes, and Nerve Impingement Syndromes. Either of these can occur independently, or together.
Overuse syndromes, sometimes called repetitive strain disorders, happen when we perform the same motions, over and over. The repeated movement causes irritation, and swelling in the joints, tendons, and ligaments. The musician perceives this as pain, although initially, it may not be very bad. If not addressed, it can become debilitating. An example of an overuse syndrome is DeQuervain’s Tendonitis, which is found in the thumb areas.
Nerve impingement occurs when a nerve is ‘caught’ between two structures. Many times you can have a nerve impingement that goes along with overuse syndromes, and sometimes the impingement is due to swelling around the nerve. These can originate in the neck region, but affect the hands and fingers. Examples of nerve impingement would be Carpal Tunnel Syndrome, and Cubital Tunnel Syndrome.
There is a myriad of problems that the musician can suffer, some more common than others. While not technically an injury, the end result is the same…. playing is compromised in some way. Allergies to wood, and metal can create major issues with playing. Hearing loss is something we all should be concerned about. Performance Anxiety is one that has received a lot of attention off and on over the years, and remains one of the biggest obstacles a musician can overcome.
The flutist who suffers from some type of injury should be informed, and know what to do, and where (and when) to go for help. It is very frightening when faced with some type of injury or complication that compromises one’s ability to make a living. This column is intended to help educate flutists about performance-related injuries, so that we are informed. The old saying ‘knowledge is power’ certainly applies here. Learning about injuries, how they develop, treatments, prevention, etc. will hopefully lead to less injuries, and more fluting!
Dr. Sandra Cox was the winner of the National Flute Association’s Convention Performer’s Competition in 2003 and 2004. Advanced degrees in the medical field, combined with music degrees, give her a unique perspective on musician health, and performance-related injuries. She is on the NFA Performance Health Committee and is a frequent presenter on performance health topics, having presented at Kentucky (KMEA), Tennessee (TMEA), Texas (TMEA), Hawaii (HMEA), Milwaukee (MTNA), China (ISME), Greece (ISME), the Midwest Clinic, International Horn Symposium, Mid-Atlantic Flute Fair, and the National Flute Association.
She is on the faculty of Southwest Tennessee Community College, and freelances in the Memphis, Tennessee area.