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sai-national.org • SUMMER 2017 • PAN PIPES 19 from overuse injuries (2-5). For the purposes of helping to prevent injury, each of these twelve factors will be presented with tips to help guide musicians toward a healthier routine. e most common symptom that presents with overuse injuries is pain. Muscle/tendon units can be troubled at their origins, at their junctions, at segments that traverse tunnels (at the wrist, etc.), or at points of insertion on the skeleton (Markison, 80). e resulting pain associated with overuse injuries can be burning or stabbing in character. Janet Horvath warns us, "But there are more subtle indicators. In its initial stages, an injury may manifest itself as tightness, cramping, stiffness or fatigue" (27). Additional symptoms can include a hot or cold sensation, tingling, numbness, or a reduced sense of touch. Norris' Overuse Factor #1 - Inadequate physical conditioning An untoned body is less resilient and more injury-prone so it is critical that musicians work to condition and strengthen the entire body. A sedentary lifestyle can lead to poor circulation and escalated pain which in turn can result in an increase of overuse symptoms. Maintaining good aerobic fitness before, during, and aer injury is critical to good long-term musician health because aerobic exercise increases cellular activity and induces a hormonal response which reduces insulin levels and increases glucagon levels. Musician-Author Janet Horvath tells us, "Muscles that are tight and weak are at greater risk than strong and flexible muscles" (23). Healthy tissue is dependent on a routine that prepares the athlete for the rigors of their workout. e available research suggests that regular stretching enhances performance and reduces injury and that it also helps neurologically to keep the proprioceptive system tuned, the muscles toned, and reactivity balanced. e musician-athlete should warm up their body core temperature before stretching and have specific goals in mind. Stretching is done to maintain flexibility in the joints and to maintain the muscles' full extensibility without tearing (Paull, 111). Norris' Overuse Factor #2 - Sudden increase in the amount of playing time While exercise and strengthening are important for overall health, special care must be given to the musician. First, during times of increased practice and heightened performance schedules (such as recitals, competitions, auditions, etc.) the amount of weight-bearing exercise should be temporarily decreased to avoid fatiguing tissues that may be experiencing overuse. Massage can be an effective way to prevent both acute injuries resulting from abnormal tissue conditions (such as muscle tearing) and chronic injuries from overuse (Weerapong, 246). For active musicians, sometimes referred to as "small muscle athletes" by the medical community, sports massage (a collection of massage techniques performed for the purpose of aiding recovery and treating pathology) may prove beneficial. ree frequently reported forms of sports massage include effleurage, petrissage, and deep transverse friction massage (Brummit, 8). is risk of inflammation and overuse during increased performance demands is greatly reduced when the musician has a healthy approach to stretching, conditioning, and exercise, however overuse of the body's bone, cartilage, tendons and other tissues can also contribute to a 'pinched' nerve. As a preventative measure, musician-athletes can keep regular appointments for chiropractic care to help prevent impingement problems. Norris' Overuse Factor #3 - Errors in practice habits Many music teachers require that their students do a warm-up routine that increases over time and pushes the student to gradually be able to handle longer and longer periods of performance. As a student matures and the demands of the literature increase the student is oen required to perform more complex exercises and fundamental routines. With almost no thought at all, there is a gradual progression instilled by master teachers over a long period of time. e body and the mind both respond better to periods of work followed by periods of rest when learning. Repetition is necessary but if done incorrectly it can be a great contributor to overuse injuries. Since the fluid that lubricates tendons is absorbed during movement and restored when resting (Fry, 49) musicians should practice in segments so that the tissues of the body can be restored. Regardless of the duration of the warm- up and exercise routine, the student should rotate the types of practice frequently throughout the routine and add periods of rest. Norris' Overuse Factor #4 - Errors of technique It is safe to assume that every musician has had their technique corrected during their training. In my own teaching I have found that I need to be particularly watchful of errors in technique developing when students are growing MUSICAL HEALTH "If someone wishes for good health, one must first ask oneself if he is ready to do away with the reasons for his illness. Only then is it possible to help him." Hippocrates

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