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Article of the week: Therapists name that tune

Rehab Regs, April 25, 2008

Why you should consider offering relief to musicians
Unlike other niche markets, finding a therapist who specializes in musicians' injuries is a challenge for many potential clients.

"Musicians put their bodies under strains that normal, everyday life wouldn't do," says Christine Guptill, BMus, BSc, MS(OT), OTR, OT Reg.(Ont), who works for the University of Ontario's faculty of music. "But there is a vacuum when it comes to services for these performing artists."

Physicians often don't know to refer their patients to an OT because the practice area is only about 20 years old. "You need to put yourself out there as an expert in the field," says Lori Stotko, OTR, CHT, chief executive officer of Mid Peninsula Hand Rehabilitation in Menlo Park, CA. "I make music medicine part of my business."

Although any musician can experience strain, there are some common instruments that cause injuries, as well as common areas of the body that experience pain. Problems include repetitive strain injuries, tendonitis, nerve compression, fatigue, and tingling or numbness.

Problematic instruments include:

String instruments-Violinists commonly experience pain, due in part how they position their instruments, as well as the volume of playing they do. Violinists often play melodic lines, so they play more notes more frequently than other instrumentalists. Pain can begin in the neck and radiate through the shoulder, arm, hand, and all the way to the pinky finger.

Woodwind and brass instruments-Woodwind players are at a higher risk of developing repetitive strain and nerve compression in their hands due to positioning, as well as the repetitive movements required for playing. Flute and brass players are at particular risk for temporomandibular joint disorders because some players fight the pressure of the mouthpiece and push out against it, says Guptill.

Piano and keyboards-Pianists and keyboard players develop hand and wrist problems but most often experience back pain from sitting in the same position for extended periods of time.

The onset of musician's injuries can occur at any time and can be found in children playing in their school band, and adults performing professionally. For many, pain occurs around the time when individuals decide to pursue a career in music. During this time, they may practice more frequently and for longer periods of time, says Guptill.

Your first step in finding musician patients is educating referring physicians about what you offer.

"Because pain is the primary symptom that motivates musicians to seek healthcare, they often tend to go to their general practitioners first," says Guptill. "We need to educate [these physicians] about what rehab can do for musicians."

Build a relationship by writing short letters to local referring physicians or developing a prescription form that they can use, Guptill suggests.

Additionally, all professional musicians are required to belong to a union called the American Federation of Musicians. Schedule a meeting with a local union representative and offer to give members an information session-both good ways to get your foot in the door, says Guptill.

Other referral sources include:

Symphony orchestras
Grade school bands and orchestras
Music schools at local colleges and universities

Referrals go both ways, according to Stotko. "Musicians contact me, and I'll set them up with doctors who are music-friendly," she says. In some cases, doctors unexposed to music medicine may tell professional musicians that they must stop playing to avoid further damage. This isn't an option for many professionals, and it can make them reluctant to seek medical treatment in a timely manner.

Because local musicians are usually a close-knit group, your patients may do a lot of your marketing for you. "Once they hear that you've done a good job with a professional musician or someone's child, you'll get referrals based on your success with that case," says Stotko.

In many cases, musicians pay out of pocket for their treatment. To collect for the services you provide, it's important that your clients find these services helpful, says Guptill. By focusing on your clients' goals-alleviating pain or adopting less risky positioning, for example-you can make sure they leave your facility satisfied with your services. This could mean coming in for multiple sessions or providing a single ergonomics assessment.

Of course, if you too are a musician, this will help you better understand the common problems these clients face, such as instrument positioning and rehearsal conduct, says Guptill.

Stotko says that of the patients she sees for instrument-related injuries, approximately half are professional musicians, and the other half are hobbyists. She uses a sliding scale so individuals paying out of pocket can decide what they can afford.

"It's hard to maintain a full practice by treating musicians alone