Along with pianists and violinists, guitarists are one of the most vulnerable musicians to hand injuries. Guitarists frequently develop repetitive strain injury and tendonitis (tendinitis/tendinitides) that may coexist with compression nerve syndromes because of non functional posture and positioning of the upper extremities during long-term practice and performance. Musicians aren’t generally known for their athletic prowess, but it is physical exertion all the same.

Repetitive Strain Injury (RSI) (also known as overuse injury) is an injury of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions. Here is the list of 5 most common guitar related hand injuries.

1. Nerve compression syndromes:

A. Carpal tunnel syndrome:
Carpal tunnel syndrome very often occurs in stringed guitarists and other stringed instrument musicians who use to play with their wrists in excessive flexion. The medical reason behind this injury is the compression of median nerve in carpal tunnel in the wrist leading to complaints like tingling, pain, numbness or discomfort in the lateral 3 and 1/2 fingers.
Further Reading: To understand more about carpal tunnel syndrome

B. Cubital tunnel syndrome:
This syndrome is caused due to ulanr nerve entrapment as the nerve passes through the anatomical structure called cubital tunnel in the elbow region and will usually only involve the fingers with ulnar nerve supply i.e. medial 1 and 1/2 fingers (ring and pinky). This is the same nerve that causes the tingling sensation when you hit in elbow. It frequently affects your fretting fingers (i.e, in left hand for right handed guitarists and vice versa). Since, both carpal tunnel syndrome and cubital tunnel syndrome are nerve compression syndromes, they involve common complaints along the region of nerve supply.

However, cubital tunnel syndrome is not as common as carpal tunnel syndrome.

2. Tendonitis:
Tendonitis/Tendinits refers to the inflammation of tendons and guitarists commonly get it in their wrists leading to tightness of muscle, connective tissue constriction and pain. This is called wrist tendonitis and it is caused due to friction and strain produced due to overuse of the wrist muscles. If you get it due to long hours and bad posture during guitar practice, you may call it guitar tendonitis.

3. Tennis elbow:
Tennis elbow, also known as lateral epicondylitis, is an inflammatory process located in the outside part of the elbow (the thumb side of the elbow). The main symptoms include pain on the outside edge of the elbow, pain when gripping especially while extending the hand at the wrist. In guitarists, the main cause leading to this injury is over-practicing and putting extra pressure on fret board than necessary.

4. Focal dystonia:
Focal or functional dystoniae are painless, stereotypic, localized movements encountered in some professional groups of patients that perform many times per minute the same tasks. Several fingers on a musician’s hand just curl up and stop responding. The management of patients with focal dystoniae is challenging.

5. Arthritis
Arthritis is the wear and tear of joints, for guitarists this could be frequently in the hand, wrist, elbow and shoulder. It usually occur at the carpometacarpal joint of the thumb and may lead to instability. The most common case is osteoarthritis where joints get worn down through overuse and begin grinding against each other.

How to prevent guitar related injuries?

Most of the times its already too late when you realize that playing guitar can cause injuries and it can be prevented easily.

1. Warm and stretch your fingers for some time with easier stretches and motions before playing complicated and swift ones. During winters you can try warming up your arms and hands with a warm water soak or shower.
2. Don’t hang your guitar too low so that you need to flex your wrist more. Metal guitarists may look and encourage you but this type of playing style encourages injuries.
3. Avoid practicing and performing for lengthy period of time and take breaks in between.
4. Always try and keep your wrist as straight as comfortably possible.
5. Icing 20-30 minutes after prolonged effort will reduce inflammation and reduce potential damage.
6. You can use ergonomic guitar and pick
7. If you experience pain, swelling, or weakness then stop playing and seek advice from doctor.
8. Taking plenty of fluids to prevent dehydration
9. Getting ample sleep

Treatment:

Hand and upper extremity disorders of the musicians should not be treated surgically and guitarists are no exception. Surgery should always be considered a last resort. Treatment may involve:

1. Physical therapy
2. Psychological support
3. Rest
4. Use of braces
5. Use of medicines, ice, vitamis, essential fatty acids, etc.
6. Use of muscle gel or deep heat

Angela Gossow Screaming

“We rehearsed and rehearsed. Then I lost my voice completely before our first Japan tour. I got diagnosed with nodules. Bad news… All these years of screaming without any technique at all had finally taken its toll on my vocal chords and struck me in the worst possible moment. I had to take 6 months off and re-learn everything. Speaking, breathing and screaming.” – Angela Gossow (Arch Enemy)

What is vocal cord nodule (vocal fold nodule or singer’s nodule)?

A vocal cord nodule is a small, inflammatory or fibrous growth that develops on the vocal cords (vocal folds) of people who constantly strain their voices. Typically it appears on the junction of the anterior and middle 2/3 of the vocal fold, where contact is most forceful. The nodules appear as symmetrical swellings on both sides of the vocal cords. People who use their voices a great deal, such as singers, teachers, auctioneers, lecturers, and politicians are the most susceptible ones.

Why singing death/black metal may give rise to nodules?

Most of the times when we are trying to sing these songs, we are doing it in a wrong way. Growls that are not performed properly may lead to permanent damage of vocal cords. If you persistently feel pain while growling, you must stop it and re-evaluate your technique because it is probably wrong.

The vocal cords in your throat are not originally intended for growling vocals. Too much involvement of throat while screaming and growling puts too much strain on vocal cords leading to nodule formation.

Bert McCracken (vocalist of “The Used”), Angela Gossow (vocalist of “Arch Enemy”), Matthew Sanders or M.Shadows (vocalist of “Avenged sevenfold”), etc. were known to have these nodules.

What is the correct way of singing these songs ?

This powerpoint presentation explains very well about the techniques.

• Hoarseness of speech
• Painful speech production
• Frequent vocal breaks
• Reduced vocal range

Treatment of vocal nodules :

• Vocal training
• Speech therapy
• Vocal rest
• Surgery

Overall health can be  achieved only through the combination of physical, mental, emotional, and social well-being. Music affects us in ways that are more direct and substantial than just about any other stimuli. It posses a profound effect on our body and psyche.

“There is no feeling, except the extremes of fear and grief, that does not find relief in music.” – T.S. Elliot

What is Medical Music Therapy?

Music therapy simply refers to a field of health care that uses music to heal. Medical Music Therapy refers to the use of music therapy strategies in the treatment of illness and the maintenance of health. It is an interpersonal process in which a trained music therapist uses music and all of its facets : physical, emotional, mental, social, aesthetic, and spiritual to help patients to improve or maintain their health. They use group therapy, individual music exercises with a variety of different instruments and techniques like writing lyrics, performing music and musical improvisation as forms of therapy.

Present status of Medical Music Therapy

• Music therapy is often practised to help cancer patients, children with Attention Deficit Disorder, etc.
• Hospitals have opted this method to help with pain management, ward off depression, to promote movement, to calm patients, to ease muscle tension.
• Some of the more useful applications of music therapy activity for elderly are in the areas of Alzheimer’s disease, Dementia, and General geriatrics.
• It has also been utilized in pregnancy, birth and gynecological disorders.
• It has also been used for the management of sleep disorders and stress symptoms.

Benefits of Medical Music Therapy:

1. Lowers cortisol as much as 25 %
2. Boosts endorphins
3. Pain reduction after surgery and quicker recover after surgery
4. Raises blood levels of Immunoglobin A
5. Eases labor without drugs
6. Stimulates neural connections in the brain and promote spatial ability and memory in children
7. Lowers blood pressure , reduces heart rate, improves cardiac output, relaxes muscle tension
8. Improves mood and mobility of people with Parkinson’s disease
9. Decreases nausea during chemotherapy
10. Helps patients participate in medical treatment and decreases length of hospital stay
11. Relieves anxiety, reduces stress and eases depression
12. Enhances concentration and creativity
13. Brings positive changes in mood and emotional states
14. Provides an outlet for expressions of feelings
15. Improves memory recall

Disadvantage of Medical Music Therapy: Pretty expensive

How Music Therapy Works ?

1. Music with a strong beat can stimulate brainwaves to resonate in sync with the beat, with faster beats bringing sharper concentration and more alert thinking, and a slower tempo promoting a calm, meditative state.
2. Music can bring lasting benefits to your state of mind, even after you’ve stopped listening. With alterations in brainwaves comes changes in other bodily functions. Those governed by the autonomic nervous system, such as breathing and heart rate can also be altered by the changes music can bring.
3. This can mean slower breathing, slower heart rate, and an activation of the relaxation response, among other things. This is why music and music therapy can help counteract or prevent the damaging effects of chronic stress, greatly promoting not only relaxation, but health.

Music Therapy At Home on your Own

1. Sit comfortably or lie down
2. Close your eyes
3. Turn on the music
4. Put on headphones
5. The music should be listened to as softly as possible (and only as loud as is necessary).
6. Listen to the music for at least 15 to 20 minutes on a regular basis

Treatment of Depression: Music Therapy or Medications ?

Music is a healer
A stress reliever

Jason Becker is an American (Richmond, California) neo-classical metal guitarist and a composer as well. When he was just 16, he became part of the Cacophony with his friend Marty Friedman. After Cacophony broke up in 1989, Jason released his first solo album Perpetual Burn in 1988. Other solo albums from him includes Perspective (1995), The Raspberry Jams (1999), The Blackberry Jams (2003), Collection (2008). He was on his way to success. However, it was hampered by his then diagnosed amyotrophic lateral sclerosis (ALS) and was given three to five years to live. Becker eventually lost the ability to speak and now communicates with his eyes via a system developed by his father. Even the disease couldn’t keep him away from something he is so passionate about. “The End Of The Beginning” a symphonic instrumental song that he composed after his disability is a masterpiece.

About the Disease:
Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease is a progressive neurodegenerative disease that affects motor neurons in the brain and the spinal cord. Motor neurons carry messages about movement from the brain to the muscles, but in ALS the motor neurons degenerate and die. Hence, the ability of the brain to initiate and control muscle movement is lost. When muscles aren’t used for a long time, they atrophy & fasciculate. Eventually, all the voluntary muscles get affected. People with ALS lose the ability to move their arms, legs, mouth, and body. It may also affect the muscles used for breathing and the person might need a ventilator to breathe. People with ALS can generally live 3 to 10 years after diagnosis. The disease can also cause personality and behavior changes.

Kinds:

1. Sporadic : It si the most common form of ALS in the United States.
2. Familial : It is the one occurring more than once in a family lineage (genetic dominant inheritance) accounts for a very small number of cases in the US.
3. Guamanian : A kind which was observed extremely high in Guam and the Trust Territories of the Pacific in the 1950′s.

Sufferers:

1. Commonly between the ages of 40 and 70, but younger people may also develop it.
2. Men are affected more often than women.
3. About 90-95% of ALS cases appear at random (no one in the person’s family has the disorder)

Causes:

The exact cause of ALS is unidentified. Researchers identified a link between ALS and Chromosome 21. Two years later, a particular gene, SOD1, was identified as being associated with about 20% of the inherited cases in families. SOD1 controls an enzyme that breaks down free radicals, harmful particles that attacks cells from the inside and cause their death. Since not all inherited cases are connected to this gene, and some people are the only ones in their families with ALS, other genetic causes must exist.

Symptoms:

Early Symptoms:

1. twitching and cramping of the muscles, especially those in the hands and feet
2. muscle weakness in the arms or legs
3. loss of motor control in the arms or legs
4. general weakness and fatigue
5. tripping and falling
6. dropping things
7. slurred or thick speech
8. difficulty chewing or swallowing
9. uncontrollable periods of laughing or crying

Progressive Symptoms:

1. shortness of breath
2. difficulty breathing
3. difficulty swallowing
4. difficulty chewing
5. tight and stiff muscles
6. complete paralysis

Treatment:
Present there is no treatment for this disease but medication includes a drug called riluzole which is aimed at symptomatic relief, prevention of complications and maintenance of maximum optimal function and optimal quality of life.