Thursday, 2 April 2015

RSI: a Really Sucky Injury

Music is most certainly an active career choice - it's physically and emotionally demanding (at the best of times) and for that reason, incredibly rewarding - but sadly this can take it's toll. Ill health and stress aside, I want to talk about one particular aliment that has caused me grief and annoyance over the last 10 years, and also caused me to develop a bizarre love-hate relationship with the brilliant composer that is Jason Robert Brown: Repetitive Strain Injury (RSI)

So - what is it? Essentially it is an injury caused by repeated and repetitive motions, so that muscles, tendons and joints are under a constant strain. The strain and motions themselves may not be very much on their own, but the accumulation of the constant repetitious movement it what leads to the aching, the pain and the loss of strength associated with RSI.
- I developed RSI during my first year studying at LIPA (Liverpool Institute for Performing Arts). It was March 2006, and I was heading to the equipment bunker returning some microphones after a band practice, when a friend of mine, who was working there, introduced me to a Norwegian girl with the statement, "Ah! Here's Lydia now, she can help you!" - It turns out that a group of students were in the middle of a production of 'The Last Five Years' (by Jason Robert Brown) for a 3rd Year performance, and their Musical Director had been taken ill and had to drop out…. 10 days before the show went up. I, in my 19 yr-old naivety said, "Sure! I can help you with that." I then proceeded to spend approximately 8 hours a day (minimum) over the next week and a half trying my damnedest to learn the piano score, learn how to conduct whilst playing the piano score, rehearse with the actors, band and production team AND somehow continue doing all my other uni work/practices and the like. It's safe to say this production, although thoroughly rewarding, was one of the most emotionally draining and physically demanding things I've ever done, and took me to my breaking point (I think I counted three separate times I was on the brink of tears…. and one where I actually did cry - but only in the privacy of my own bedroom) - but what I didn't expect was the aftermath: this horrible aching setting into my wrists, an aching that 1 week after the show run finished was still there…
- A long story short, my piano teacher put me on 'performance rest' for 4 weeks, and showed me a selection of stretches to help ease out the tension. 'Performance rest' was actually easier than I anticipated, but only because it fell over the Easter Holidays, 1 week of which I was spending at a student drama festival, and another in a villa in Spain (where there wasn't a piano in sight for either place) - it made it harder to not practice, what with summer term assessment coming up, but I followed his advice, and the problem seemed to correct itself - at least so I thought….

JRB's L5Y.... Sounds amazing.... hurts like hell!
A few years ago the old issue reared its ugly head again, plaguing my very livelihood - now working regularly as a performer, taking time off for 'performance rest' just didn't seem to be an option without locking myself away in some remote area of the world with no musical instruments to hand (all the while losing a significant amount of income). The issue would come and go, and obviously it was made much worse by prolonged periods of playing piano (or cello, or guitar!) - Then last summer was the very worst bout of it: I got asked to Musically Director ANOTHER production of 'The Last Five Years'. Jason Robert Brown was back to torment me with his massive hands and insanely difficult (albeit, awesome) piano writing. Now, I thoroughly enjoyed this production, one of the best I've ever been a part of, and I will say that my playing technique was much, much better than 8 years previously, but when the run finished the aching was persistent and very upsetting. I decided, I'd had enough of just 'strapping up' and 'trying not to play too much' - I decided I needed to some serious research and try and fix this problem for myself. I'm a professional musician: short of cutting my hands off, performance and piano playing aren't stopping anytime soon.

From my research I've deduced a few things.
- A repetitive strain injury (RSI) is an injury to the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained or awkward positions. It's a bit of an umbrella term that covers various similar ailments (like carpal tunnel, or tennis elbow etc.) RSI is also pretty common: with the advancement in technology and the majority of people working with a computer, RSI seems to afflict a significant chunk of people. - Unfortunately, I find that almost all of the information I come across is geared towards computer users experiencing RSI, and sometimes athletes, but not musicians so much. Some of the information is useful, granted, but I'm still hunting for more 'music-specific' RSI treatment information - That being said, I've come across a fair few options that I'm using right now and would recommend:

1) Physiotherapy: My physio works on my neck, upper back and forearms, and also uses ultrasound and interferential (electro-therapy) to help alleviate my symptoms - I've also done my own research on things my physio called, "Trigger Points" - essentially the muscles that are responsible for my wrist pain are actually not anywhere near my wrist - the link below is really useful for sussing these trigger point out:
http://www.triggerpoints.net/symptom/dorsal-wrist-hand-pain

My physio (and university piano teacher) have shown me a variety of stretches for the neck, arms, wrists and fingers that all help improve the tensions (and if done regularly are preventative) - The link below shows some good stretches:
http://bps.musespeak.com/2013/03/arm-and-hand-stretches-for-musicians.html

There's also a lot of evidence that certain exercises that strengthen the back, shoulders and arms greatly reduce the issue of RSI, for example Swimming or Yoga - however, I've yet to find the time to go swimming (which I do actually enjoy), or do yoga..... so watch this space on that one!

It's such a shame dayglo-pink isn't my colour...
2) Kenesio Tape: My physio uses this after our sessions for support and to help with improved blood flow (you'll see many athletes wearing various colours of this: the best example that springs to mind is Tom Daley wearing yellow tape for a tricep injury) - Some people seem skeptical of this tape, and I'll admit that, while I was wearing it for the first time I wondered what the point was, but once it's removed you really do feel what it was actually doing. It's worth a try anyway, because it doesn't hurt..... except to rip it off.... it sticks pretty well!

3) Thermoskin wrist supports / splints: I have a variety of these: a flexible (but study) wrist wrap support which I wear most often when the aching or pain sets in, and a wrist splint that I wear mainly at night (when needed), or if the pain is incredibly bad.

4) Wrist Warmers: My RSI feels so much worse in cold weather (probably due to restricted circulation), so I try and wear gloves and wrist/arm warmers as much as possible (and I find them a somewhat stylish way of covering an unsightly wrist support). The better your circulation, the better your body works - simple science really when you think about it.

5) TENS Machine - This little gadget works in a similar way to the interferential treament my physio gives me. It sends electrical pulses into your muscles via sticky pads placed directly over the sore points: it can feel really weird, but I find it's great at loosening up tense muscles - when used in conjunction with 'trigger points' I find this can really help improve RSI, and lessen the amount of times I need to visit the physio (which my wallet is very appreciative of).

6) Ibruprofen Gel: I find this the quickest way to get pain relief to my muscles. Ibruprofen pills help too (make sure not to use them at the same time), but I find the gel targets the area quicker. Also, you can gently massage the inflicted area as you rub the gel in for a double whammy of relief.

Exotic fruit... or healing super food?....
Another area that's popped up in my reasearch is supplements and vitamin thearapy: I'm currently experimenting with supplements that are meant to help RSI - these vitamins and minerals are said to be anti-inflammatory (and can be found in foods or supplement form):
  • B vitamins: (found in avocado, bananas, nuts and various other foods)
  • Bromelain (found in pineapple and grapefruit)
  • Vitamin C: (found in citrus fruits)
  • Omega 3's: (found in fish oils and flax seeds)
  • Glucosamine (supplement for joint pain)
My RSI is far from fixed, but I'm feeling pretty positive about the steps I'm taking to at least make it more manageable, and I think employers are starting to be more receptive to how debilitating and upsetting this aliment is. When I applied to do some cover work at the Guernsey Performing Arts Centre back in September 2014, I wrote on my health form about my RSI, and the education department did actually contact me about it, asking whether there was anything they could do to help my RSI, or reduce the risk of a flare-up. I'm hoping that every employer (particularly in offices) offers this kind of support, or if they don't, that they will do in the very near future.