In Emily Duncan’s hands, playing the flute looks like a very cool job. At 28, Duncan, a New York native and Juilliard graduate, has taken her career around the world and across music genres — performing in classical concert halls and off-Broadway folk musicals, and even touring with a symphony orchestra playing only David Bowie songs played. A lifelong musician, Duncan was living her dream until a simple injury, which she now knows could have been prevented, nearly ended it all.
One of Duncan’s hands stopped working. Her symptoms began with occasional tingling in her fingers and slowly progressed to frequent pain and numbness in her hand. The impact on their ability to play – and their emotional well-being – has been profound.
“It was pretty devastating,” Duncan said. “For me, being a musician isn’t just a job, it’s a calling and an attitude towards life.”
For the next four years, Duncan kept her injury a secret from her fellow musicians while enduring countless doctor visits, physical therapy appointments, nerve tests and painful steroid injections. Despite this, no one could give her a definitive diagnosis or provide her with safe, long-term pain relief. Another option was surgery, but she was afraid it would permanently damage the nerves in her hand and her ability to play music.
In pain and emotionally disturbed because her career was on hold, Duncan approached an occupational therapist at the Hospital for Special Surgery in New York City, who explored an unusual protocol for treating injured musicians: treating them like professional athletes.
Aviva Wolff pioneered an innovative approach to treating sore hands and arms. She used advanced motion analysis and technology more commonly used in professional sports or in movement disorders such as Parkinson’s disease.
When the trained hand therapist Wolff saw the devices for the first time in her laboratory at the HSS, she recognized their untapped potential. “I mean no offense to the feet but there are only so many things you do with your legs like walk, kick, dance. But our hands and arms? We do hundreds and hundreds of different things.” Wolff began researching upper body biomechanics.
By some estimates, up to 90% of professional musicians suffer an overuse injury due to improper form or poor posture. Wolff said it was also a big problem with amateurs, especially self-taught ones.
New York City proved to be Wolff’s mecca for the study of professional musicians with upper extremity pain—particularly violinists, violists, pianists, keyboardists, and guitarists. The most common of these injuries are carpal tunnel syndrome, tendonitis, or bursitis of the shoulder or elbow.
In her lab, Wolff attaches motion sensors to each musician and uses multiple cameras to analyze the biomechanics of their game, an approach similar to what athletic trainers and conditioning coaches do with professional athletes to map out a golf swing, basketball jump shot, or pitching form optimize. Most of the musicians’ pain is chronic, and high-tech motion analysis allows Wolff to identify abnormal hand or body positions that are aggravating their injuries.
While the bodies of musicians and athletes are similar in some ways, they differ in a key aspect of how they perform. “Unlike athletes, musicians have to play without tension,” said Wolff. “With professional musicians who use their bodies optimally, you can see how light they seem. It seems effortless and that’s what you want to see.”
Tomo Fujita, a professional guitarist and associate professor at Berklee College of Music in Boston, said another distinction between injuries in the sports and music worlds surrounds their injury cultures.
Athletes are open about their injuries and treatments, but it’s a different reality for musicians, especially classical players like Duncan.
“For some, if you say you’re in pain, that could mean you have a weakness,” Fujita said. “It’s almost like saying you’re not that great a musician.”
Fujita acknowledged that unlike athletic coaches, music schools and educators spend little time teaching specific methods of preventing injuries. He said he’d like to see someone consistently teach that playing an instrument a certain way can hurt you.
“It needs more emphasis and not just something you might get a newsletter about every three months.”
Wolff is currently developing an injury prevention and treatment curriculum for conservatories and orchestras that includes anatomy classes, stretching exercises, and practice for each instrument. She also trains her medical colleagues with research from the Motion Analysis Lab, which identifies specific ways to get injured musicians back playing in the short term and in better shape over the long term.
“We don’t know enough about the needs of musicians,” she said. “The musculoskeletal system and our body are healing machines. There are solutions out there.”
As with all of her patients, Wolff created a customized “return-to-play” plan for Duncan, using the data she had collected through her motion analysis studies.
A surprise: Although Duncan experienced pain and numbness in her hand, Wolff pinpointed exercises for an area no one else had identified as a potential source of pain — the upper back muscles.
“It was really enlightening for her to say, ‘You’re feeling the symptoms here in your hands and your wrist, but actually, if you strengthen those muscles in your back, it’s going to relieve your symptoms,'” Duncan said.
Now Duncan feels secure about her future and her ability to continue doing what she loves most, in the place she loves most.
“Slowly but surely, as New York comes back, I’m coming back,” she said. “It’s nice to be able to make music again.”
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