Assessing the instrumentalist interface: modifications, ergonomics and maintenance of play.

Awareness of the tasks required to play a particular instrument requires observation of technique and understanding of the dynamic and static loads placed on the musculoskeletal system to play a particular instrument. Anatomic differences, variation in hand size, gender, instrument choice, and maintainance of the instrument all may play a role in the development of playing-related complaints. Simply observing particular instruments, we can see a variety of positions that are required to play the instrument. Important to the discussion of overuse syndromes, we must evaluate the duration of practice sessions and warm-up and cool down periods, which may help minimize playing-related problems. Avoid absolute rest and opt for relative rest for playing-related problems. Immobilization for more than 3 to 4 weeks may lead to greater risk of injury when playing is resumed. Return to play schedules should start with simple, soft music, doubling minutes of playing every few days, dropping back if pain develops. Practical advice may include building up practice times gradually with 5- to 10-minute intervals in 60- to 90-minutes sessions. This recommendation is supported by the findings of Lutz and colleagues who showed decreased blood flow to the forearm after repetitive hand and wrist activities for 90 minutes. This decrease in blood flow normalized after 5 to 10 minutes of stretching exercises. Players with hypermobility should consider limiting practice sessions to 45 minutes allowing for rest breaks of 10 to 15 minutes. Fry suggested a shift in thinking of ergonomics as sa reactive strategy to one in which we anticipate and prevent problems before they become insidious or severe enough to limit the ability of the instrumentalist to play. Joint protection is important in all musicians, and although youth can be forgiving for many, we must remind our patients about joint protection as it applies to activities of daily living. Instrumentalists rely on their hands and finger joints to allow them to perform. Basic principles that apply to patients with all types of arthritis also apply to our patients when activities that worsen symptoms or place unnecessary stress on joints are identified. Using adaptive equipment to open jars is an obvious example. Overall, engaging the patient to observe routine behaviors may lead to the identification of modifiable activities, which might be aggravating or manifesting as a playing-related discomfort. Although some injury patterns can be associated with particular instruments, remember that your guitar-playing patient may be taking drum lessons on the side, Which could result in lateral epicondylitis that bothers him when he plays the guitar.