There are many kinds of pain, ranging from little hurts to full blown, intense pain that cannot be ignored. There’s physical pain, mental pain, emotional pain. How do we deal with pain as musicians? How do we know when it’s time for the doctor or when it’s just a little thing that will get better on its own?
Pain is a strange thing
We’re taught that if something hurts, we shouldn’t mess with it but just leave it alone. When doing physical or occupational therapy after an injury, however, the movements and the stretches hurt but are absolutely necessary in order to regain function. Some modalities within the manual therapy world go right to the sore spot and hold pressure there. What? Mash the sore spot on purpose? Yes! It’s called trigger point release therapy. Some people have a very high tolerance for pain, which is especially worrisome if one of these lucky folks is your child, while other people have such a low threshold for pain that a simple paper cut becomes unbearable. According to “Musculoskeletal Symptoms Among Finnish Professional Orchestra Musicians,” published in the Dec. 2017 issue of Medical Problems of Performing Artists, the prevalence of work-related musculoskeletal problems is high, ranging between 73% and 88% depending on what particular study you look at.1 Let’s assume that “musculoskeletal symptoms” means pain. How do we make sense of “pain” since there are so many different types of pain and we all experience pain differently?
What does science say?
Interestingly enough, pain science is a relatively hot topic in the research world. There is a pain science conference called the San Diego Pain Summit (https://sandiegopainsummit.com/), held annually since 2016. There are websites such as https://www.painscience.com/ which link to articles, tutorials and tips about pain. There is a lot of information available, yet much of it is pretty technical in nature. Which parts of this research are most valuable to us as musicians?
What we now know
A great place to start learning about the science of pain and how we process it is to read “A Guide to Better Movement: The Science and Practice of Moving with More Skill and Less Pain”(https://www.amazon.com/Guide-Better-Movement-Science-Practice/dp/0991542304?SubscriptionId=AKIAIOCEBIGP6NUBL47A&tag=&linkCode=xm2&camp=2025&creative=165953&creativeASIN=0991542304) by Todd Hargrove. The author, a former attorney, is a blogger and a certified Rolfer and Feldenkrais practitioner, and he writes and speaks about emerging science relevant to manual and movement therapists. https://www.bettermovement.org/ The following information about how pain works comes from Chapter 5: The Science of Pain from his book mentioned above.
1) “Pain is a conscious experience created by the brain, not a damaged condition of the body. You can have one without the other” (p.92). There are patterns of neuromuscular activity which tell the brain to “CREATE PAIN NOW.” We know that the sense receptors for vision, called photoreceptors, are located in the retina of our eyes and they send the information up to the brain. The brain converts the information into an image. The sense receptors input the information and the brain builds the picture. Similarly, nocioceptors are sensory receptors on free nerve endings throughout the body which send information about noxious stimuli to the brain. They can detect changes in chemical, mechanical, or thermal stimuli. They send the info to the brain and the brain decides if this stimuli is dangerous enough to warrant further action. So the pain is created by the brain! The nocioceptors are just sending information, which isn’t bad or good, painful or pleasurable.
2) Pain is for protection. Let’s say you’re shoveling your driveway and you fall. You try to push yourself up to a standing position and experience blinding pain coming from your right wrist when you try to push it down onto the snowy ground. It could be that you’ve broken a bone and your brain is saying “Hey, don’t put weight on this hand. There’s a problem here.” You, then, instinctively cradle your wrist against your body to minimize the damage This is what’s supposed to happen. Sometimes, though, the brain doesn’t realize that the injury is healed and the protective compensation pattern is still present. This shows up by continuing to cradle your healed and fully functional wrist up against your body. I worked for many months to eliminate the holding pattern that I had after reconstructive hand surgery.
3) Pain is output, not input. Social context matters. Consider a toddler who takes a terrific tumble off the climbing wall at the playground. The child gets up, starts brushing herself off and generally going about her business. The terrified screaming only happens when the well intentioned parent comes running over in panic mode. It doesn’t hurt until somebody is looking? Yes, emotions and other sensory cues are used by the brain to figure out “is this situation dangerous?”
5) Tissue damage does not correlate with pain level. There are examples of soldiers running across the field of battle, only realizing that half their foot is missing after the fighting stops. In the heat of battle, they were completely unaware of the injury. This makes sense. If you’re running for your life, it doesn’t matter if part of your foot is gone. The bigger threat is the incoming enemy fire. We’ve all experienced getting a bit of salt or lemon juice into a fairly minor cut on a finger. In my experience, which is certainly not the same as everyone else’s experience, I’ve found this to be a ridiculous amount of pain for a relatively minor tissue damage. In his book, Hargrove references a number of studies about the lack of correlation between pain and MRI findings. Many people with severe back pain have perfectly normal MRIs and people with no back pain whatsoever show disc herniations. The specific numbers are available in the book starting on p. 95.
The conclusion to be drawn is that pain is not just one thing—it changes from situation to situation and person to person. Different variables affect the sensation of pain.
So what? What does this mean for us as musicians and humans?
Dr. Perry Nickelson from Stop Chasing Pain ( http://www.stopchasingpain.com/) says, “Pain is your body’s request for change.” Your body doesn’t like something that you’re doing and you need to make a change in your behavior.
If the pain is just a little twinge in our wrist every now and then, what do we typically do? Most of us tend to ignore it and keep playing along until the pain becomes so bad that we can no longer play through it. At this point, most of us go to see a medical provider and rightly so.
But what if we became truly intelligent listeners to our bodies and responded to those initial twinges? Perhaps, the big pains could be avoided if we dealt with the little pains sooner.
If you notice a pain/discomfort while practicing, what steps should you take? You need to start investigating. Maybe you need to adjust your head position or your hand position. What movements make it worse? What movements make it better? Did you do anything differently in the last few days? Any sudden increase in practice time? Sudden increase in difficulty of repertoire? Did you make exceptionally bad dietary, pharmaceutical, and sleep choices?
After gathering your info and trying to implement some changes, sometimes you can resolve your pain problem on your own. Many times, though you will need to consult with somebody else because if you knew what was going wrong, you wouldn’t have the problem in the first place! We don’t know what we don’t know and it’s nobody’s fault. There are many kinds of professional people who can potentially help – doctors, chiropractors, movement educators, manual therapists, acupuncturists, and others.
As a long time movement and music educator and brand new manual therapist, I love to study movement and want to help my clients move better in all activities they do. Through my work with professional musicians and college music students, I do see patterns of misuse that can and do lead to pain and injury. Making better movement choices can improve technique, enhance the musicality of your performance, and help you out of discomfort. Many of my future articles will address specific issues that are relevant to many musicians. However, we are all different. Individuals have preferences for certain modalities. You may need to experiment to find what is going to work the best for you. If you have specific topics that you would like to know more about, please email me at kmollnow@mac.com.
References
1) Viljamaa, K., Liira, J., Kaakkola, S., & Savolainen, A. (2017) Musculoskeletal symptoms among Finnish professional orchestra musicians. Medical Problems of Performing Artists, 32(4), 195-200.