Thursday, December 29, 2011

Tendonitis of the brain

I took classical music history this past semester in order to fufil one of the musicology diagnostic exams I failed (I failed all of them). I felt like I was learning everything for the first time, which makes sense given my less-than-stellar undergraduate study habits. It wasn't until we got to Beethoven that things began to feel familiar again; I didn't start paying attention in my undergraduate class until Beethoven.

In musical academia, we tend to idolize Beethoven as the tragic hero of romanticism--a man who fought poverty, addiction, and ultimately his own loss of hearing, and was still able to express his artistry through music. His famed Heiligenstadt Testament provides us with a direct account of Beethoven's struggles from the composer himself:
Oh, how could I possibly admit an infirmity in the one sense which ought to be more perfect in me than others, a sense which I once possessed in the hight├ęst perfection, a perfection such as few in my profession enjoy or ever have enjoyed. – Oh I cannot do it... (full text here)
I remembered this quote vividly from my undergraduate class. In fact, I remember the profound emotional reaction I had when reading this quote. You see, the reason I started paying attention when we got to Beethoven in my undergrad was because that was when my injury had fully manifested itself. I could no longer play, so my attention turned towards my academics. Reading this document hit close to home because frankly, I felt the same way.

There are some fairly significant psychological implications of tendonitis and other musical-related injuries, and affects students and teachers alike. I've gotten to a point in my career now that I have been on both sides of this fence.  When dealing with an injury, whether it be your own injury or a student's, there are a couple of things I want to bring to the surface.

1. It's not your fault. 

 For some reason, we human being have a funny fixation with needing to find a scapegoat for all circumstances in which we find ourselves. Identifying the cause of the injury and blaming somebody for it are not the same thing.  More often than not, an injury like tendonitis is rooted in "too much playing."  For a student, that means they are practicing quite a bit.  This puts teachers in a really awkward place.  Is it the teacher's fault for making his or her students practice too much?  Or is it the student's fault for not practicing more responsibly?

From personal experience, let me assure you that I never once blamed my teacher for what happened to me.  My injury stemmed out of a combination of an incomplete understanding of technique, poor practice habits and a whole lot of enthusiasm.  As a teacher, you have to push your students to work hard.  If your student develops a repetitive stress injury because they are trying to do well, the only thing you can be held accountable for is not providing them with proper guidance to heal their injury.

That being said, the worst thing a teacher can do is come down on their student, or allow the student to place the blame on his or herself.  Tendonitis should not be a punishment for working too hard.  Remember, more often than not, this injury came about with the best of intentions.  You want your students to practice a lot, so for a student to feel at fault for practicing too much can be extremely detrimental to his or her success.  Remember, placing blame is irrelevant--focus on identifying the problem and healing the injury.

2. There's nothing wrong with you


When I was injured, I spent way too much time looking for answers in the wrong places.  Instead of searching for a solution to my problem, I spent too much time searching for the cause.  Remember that whole "placing blame" thing I was just going on about?  I was trying to figure out why I was having problems, while nobody else was.

Look, the fact of the matter is getting injured isn't really that unusual.  It is concerning, alarming, even devastating, sure, but it's not unusual.  This is something that I feel like a lot of teachers haven't come to terms with yet, especially those who did not grow up in the digital age.  Society today demands a lot more use of your fingers and arms than ever before--texting, typing, and clicking are all repetitive stressed that get added on top of your regular practicing.  To sustain a repetitive-stress injury is a big deal for a musician--but it's not uncommon.

Don't forget--as musicians, what we do with our bodies is on par with Olympic athletes, just with smaller muscles.  If an athlete injures themselves while training, it's not terribly surprising--in fact, it's so common, that "sports medicine" is a viable career option for many aspiring physicians and therapists.  No matter how young you start playing, or how strong you are, or even how responsibly you practice, you are not invincible.  If your rely on athleticism in your career, whether it be running, constant computer use, or playing marimba, you are asking your body to perform to it's extremes.

So, why is it that some people deal with injury, while others never do?  The answer is simple enough: everybody's different.  I can't really say for sure what it is that prevents person a from sustaining person b's injury, even when they are following the exact same course of study.  Once again--placing blame isn't going to help.  There are instances where a pre-existing condition may cause somebody to be more prone to injury than others, but chances are you would already know about it before you became injured.  For this reason, teachers can have a hard time understanding why their students are dealing with injuries that they never had.  Just remember--your students are different people, growing up in a different time.

3. Do something about it


I'll tell you more about what to do in future blog entries, but what I need to make clear now is that your injury will not go away on it's own.  This was probably my biggest mistake when I first began dealing with my injury.  Taking time off from playing does not heal you.  I can't stress this enough.  In fact, I'm going to say it again, in it's own paragraph:

Taking time off from playing does not heal you.


David Shulman, the Towson-based physical therapist who was largely responsible for healing my injuries, would always tell me: "If taking time off could fix your arms, I wouldn't have a job.  You would go to the doctor, be evaluated, and the doctor would pull out his book, and say 'you have tendonitis--I'm prescribing three months of rest.'  But that's not how it works."

Time does not heal all wounds.  Our bodies are equipped to handle healing things like a cut or a scrape or a bruise or anything else that happens in the daily struggle to survive.  However, playing an instrument is not natural and our bodies aren't equipped to naturally rectify the ailments associated with it.  When you sustain a music-related injury, it is something you have done to your body over a long period of time.  Therefore, you need to do something to your body to get rid of it.  If I had known this from the beginning, my injury would have been much less severe, and would have healed much more quickly.

That being said, it's important to consider the distinction between being sore or tired from a long day of practicing, and actual pain caused by an injury.  If you've been practicing a lot and your arms feel really tired, than you need to stretch, rest, and let them recover.  If you are experiencing pain and discomfort for an extended period of time after practicing from an isolated area, especially if it is painful to touch, you have reason to be concerned.  I'm not a doctor, and I can only speak of my own experiences.  The best I can do is tell you to listen to and trust your body.  It will be very clear when enough is enough.

4. Don't be afraid to play your instrument


This is really a post-injury concern, but is certainly worth addressing.  One of the longest side effects of tendonitis I dealt with was being afraid of having any tension in my body at all.  As I became able to play for longer periods of time, it took me a while to be willing to get a lot of sound out of my instrument, or conjure up more violent and tense spirits in my music that I was able to perform before.

It takes a certain amount of tension to play your instrument.  As I recovered from my injury, I spent a lot of time focusing on reducing the amount of tension in my playing.  I had a lot of really bad habits, and over a long time, managed to get rid of most of them.  However, when it came time for me to play music that demanded a more agressive, violent, or otherwise emotionally tense character, I was pretty unwilling to do this.  Tension is something that needs to be harnessed, not feared.


There are certain parts of your body that hold tension better than others, and there are more appropriate times for those parts of the body to hold that tension.  This is something that I'll go into more detail in when I talk about different muscle groups and their uses.  What needs to be avoided is constant, unnecessary use of tension.  This tension, more often than not, stems from poor technique, and can lead to an injury.  However, proper and efficient use of tension is not damaging, and more musically effective.

Remember that there are ways of reversing the effects of tension, such as massage, stretching, and exercise. The most important thing to know is that while tension should be avoided, do not let the fear of tension negatively impact your playing.  We are musicians first and foremost--even if you recover from your injury, you haven't really fully recovered if you cannot play your instrument the way the music you're playing demands.

Anyway, I want to leave you with one thought.  And it was my thought, during the midst of all of this:

This is what you get for trying too hard.


All of the points I brought up can go back to feeling this statement.  Trying to place blame, trying to understand why I was injured in the first place, trying to figure out what to do about it, and even after I began to heal--it all came back to this idea.  But, I consider myself fully recovered now because I've gotten over this attitude.  My injury, and the process of recovery, lasted about two years.  But without confronting this attitude, it could have lasted for much longer.

I'll leave this here for the time being, but I'm sure there is plenty left to be discussed.  I would love to hear your input!  This is part of a larger project for me, so any ideas, criticisms, and suggestions are welcome.

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