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THE HAND OF MUSICIAN

 

 

Pathologies that torment the hand and the upper limb in the musician have become more and more common and frequent. Such a pathology does not represent a new set of diseases, but simply a group of troubles that for a great deal of time have been undervalued and ignored even because of their symptomatology a little or badly defined. Formerly one frequently used to ascribe such a symptomatology even to troubles of psychic origin. Thanks to recent epidemiological studies remarking the frequency with which some specific symptoms strike the hand of musicians, an increasing interest in medical environment was able to develop for study and treatment of these phenomena. In consideration and study of this pathology, one has to remember musicians often have a professional career beginning yet in young age, in some cases even before the end of growth. These factors, together with the fact that a professional musician spends many hours a day to practise and have a correct neuro-muscular activity, make them to be vulnerable to phenomena of degradation of joints related to “over use” in greater percentage in comparison with average of population. To understand the intensity of stress to which the joints of hand of musicians can be struck, it’s enough to think they are able to produce, playing, to 30 notes per second. Besides the hand, with different pressure and intensity, gives each note a particular sonority; for these reasons we can understand the complexity and criticality of all his functions used at the same time. We also cannot forget that, when in front of a musician, we are in front of an artist , and that the difference between the man and the artist is represented by the presence in the last one of a greater emotionalism and sensibility, which makes for the artist music is the main topic of his real existence. Pathologies that torment the hand and the upper limb of musicians make them to suspend temporarily their activity every year, to take care adequately of their pathology. Probably, if preventive measures could be adopted, much of these pathologies could be avoided. To correctly appraise the validity of preventive measures able in reducing the risk of onset of these pathology, some factors have to be considered, as the sort of musical instrument used, the time dedicated to exercises, and to practice, and some purely individual factors. Each type of musical instrument, depending on its form, its weight, on position to be held when played, and on the pressure to give to have a correct sound, could be accountable for onset of any specific and particular pathology. Someone of the most simple preventive measures that one could be able to adopt to avoid the onset of these pathology, is a correct ergonomic hold, a modification of form and weight, the use of accessories reducing stress and work in transport.. An other trick for prevention of pathologies of musician hand, could be the introduction, during the exercise and the musical study, of periods of work alternated to periods of rest. Correction of “ vicious “ postures is very important it is of fundamental importance that the symmetry and the equilibrium of hips and shoulders could maintained correct, avoiding the excesses of strength and pressure, alternating periods of work with periods of relaxation in cooperation with kinesitherapy. For formation of a musician when he is yet in a young age, the consideration of the neurophysiological aspect assumes a remarkable value too. It is important to appraise when the boy can be approached to the music and when he is able to distinguish the melody from the harmony and above all when he is able to learn the musical language. Also the gestual expressiveness necessary to the sound of an instrument requiring repetitive exercises, possible only after reaching a suitable neurosinaptical development, makes it necessary to individualize a correct age when to approache the boy to the musical instrument. In base to in-depth studies relating to the considerations previously listed, it has been possible to identify such an age in an inclusive range among 7 and 10 years. During this period of growth however it has to be considered that the intense exercise, to which the child can be submitted for the study of music with an instrument, if is not performed correctly can be cause of anomaly of the posture of the upper limb and of pelvis and of spinal column. This makes it necessary, during teaching of music and of use of an instrument, that gestures and of postures to perform and to hold correctly could bee taught adequately. In a teenager the appearance of scoliotic deformity of the spinal column, can be not an exceptional event, and if it is not related to the practice of a musical instrument, it can be increased with its use. This makes advisable to address a teenager to a program of reeducational gymnastics, if he decides the study of a musical instrument to undertake. The gymnastics by themselves are not enough; it is better if they were integrated by indication to the carrying out of sporting practices. Each type of musical instrument involves different possible center of onset of possible pathology correlated to its use; for instance, if we consider the wind instruments, one can understand how it could be useful for teenagers playing them, to undergo to controls for evaluation of dental articulation and check maxillo|-facial to follow the corrected and regulate evolutionary process of growth of maxillary complex. Most of these musicians, amateurs or professionals, sooner or later, during their career, develop pathology of the muscle-skeletal system.

These troubles are directly proportional to the practice of the musical instrument and they are represented by pains interesting the hands, the wrist, the forearm, the shoulder, the neck and/or the back. These pains can be referred to tendinous, muscle-tendinous pathology, muscular and/or, articulate, and even to compression neuropathies. Yet the greatest stresses they have during the use of musical instruments, strike the hand and the fingers, for generally the rest of the body remains more or less immovable. Practising daily, with an instrument, during several hours and days per year when at a high professional level requires a great force and a quantity of work ( as manual exercise ) really considerable. This creates the basic conditions by which the syndrome “overuse” takes origin. It creates such a situation when the demand of practice of exercise overcomes so much the tissue capacity It’ s obvious that in presence of such a picture the errors of posture and of technique during the use of a musical instrument favours still more the rise up of these muscle-tendinous pathologies. These pathologies are more and more frequent if at the same time the concomitant presence of ligamental hyperlaxity exists. The diagnosis of these muscle-tendinous diseases striking musicians is based particularly on a careful clinical evaluation accompanied by a deep analysis of the maintained posture during the use of instrument and of gestures made to play . The treatment of these troubles, if it had not been possible avoid the onset by a correct prevention, is based above all on a specific rehabilitative program. For a correct interpretation of a musical passage, often the musician is forced in complete unnatural and contradictory movements like to press and release and as movements of precision and of relaxation. This way to use hand and fingers do not let them to move in a plastic and harmonic mode and contemporarily even in an ergonomic manner. A correct re-education of musician pathology for “overuse” cannot leave out a global evaluation of the body driven to the restoration of an equilibrium both physical and psychological of the artist; in other words: “it takes care of the symptoms and of functional deficit.” The treatment of symptoms from “overuse” requires a period of functional more or less long rest, during which is anticipated the aid of a specific orthesis for the sort of |tendinopatia| presented by the musician. The orthesis however must guarantee the mobility to that articulations that do not act out of self-interest from the pathology. Subsequently to the rest, it must begin a program of passive and sweet re-education when is taken an oath gradual and slow reapproaching to the musical instrument and when it is possible to the it makes by the use of a dynamic |split|.