[Paleopsych] CHE: Medicine for Musicians

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Medicine for Musicians
The Chronicle of Higher Education, 4.10.15
http://chronicle.com/weekly/v51/i08/08a05601.htm

    By KATHERINE S. MANGAN

    Denton, Tex.

    Listening to Michael Adduci play a haunting melody on his oboe with
    the Fort Worth Symphony Orchestra, you might think he has a cushy job.
    But peer down his nose -- with the help of a fiber-optic cable and a
    computer screen -- at his vocal cords that pulsate with every breath,
    and the sounds he emits don't seem so effortless.
    "We say we're 'playing' our instrument, and we sit in comfortable
    chairs," the University of North Texas doctoral student and adjunct
    music instructor says as he looks up from an uncomfortable-looking
    contraption that includes a cable being laced into his nostril by a
    gloved researcher. Later, he will view the information projected onto
    a computer screen to analyze his playing technique and determine
    whether he is causing unnecessary strain on his vocal cords. "No one
    thinks about the risks involved," he adds.
    Researchers at the Texas Center for Music and Medicine are trying to
    change that. The joint project between the University of North Texas's
    medical and music schools treats musicians for injuries and illnesses
    that, if left untreated, could end their careers. And it is spreading
    the word to music schools across the country that playing music
    professionally doesn't have to be hazardous to your health.
    Most people probably don't know that an overzealous trumpet player can
    rupture his lip muscles or ruin his teeth or that more than a third of
    clarinetists suffer pain in their right wrists. A percussionist in a
    high-school marching band who hoists around a heavy drum for hours
    under a blazing summer sun can suffer heat stroke, while the same
    musician cooped up for hours in a small practice hall can suffer
    hearing loss.
    The risks are emotional as well as physical. Touring musicians whose
    lives are a blur of nightclubs and cheap hotels can succumb to drug
    and alcohol abuse and depression, while stage fright can strike both
    seasoned veterans and novices.
    The interdisciplinary center, which is supported by the National
    Academy of Recording Arts and Sciences (the organization that awards
    Grammies) and the National Endowment of the Arts, helps musicians
    change physical habits that lead to injuries and focuses on underlying
    psychological problems that can leave them vulnerable to drug abuse
    and depression.
    Music is more than a pastime for most students at this Dallas-area
    university, which has a renowned jazz program and more than 300
    practice rooms and six performance halls for everything from opera to
    rock. It also enrolls hundreds of aspiring music teachers like Mr.
    Adduci, whose goal right now is to survive this lab experiment on him
    and his oboe.
    Dressed in jeans, a white Guayabera shirt, and sneakers, with
    close-cropped hair and black-rimmed glasses, he barely winces as an
    associate professor of speech pathology, Fang Ling Lu, inserts a
    quarter-inch fiber-optic cable up his right nostril and down into his
    throat. He continues playing a scale while the larger-than-life image
    of his vocal cords pulsates on the computer screen behind him. By
    examining the image, Ms. Lu can monitor how the muscles contract when
    he hits high or low notes and whether his throat is red or swollen.
    Looking on is Kris S. Chesky, director of research and education for
    the music and medicine center. A former professional trumpet player
    who played gigs ranging from cruise ships to smoke-filled bars, Mr.
    Chesky majored in music and engineering in college. For most of his
    career, he has been examining the intersections of music, medicine,
    and engineering. (He holds a patent on a stretcher that uses musical
    vibration to help ease postoperative pain.)
    Right now he is developing health-promotion curricula to introduce in
    music schools around the country and, earlier this month, played host
    to a national conference for music and medical professors to discuss
    ways to protect musicians' health.
    "The people who are teaching music were never told that, just like
    chemistry or shop class, there are risks involved with music," he
    says. "We're trying to change that culture."
    Other universities are helping out. A center at Vanderbilt
    University's medical school, for instance, provides treatment by ear,
    nose, and throat specialists to people who are seeking relief for
    their overstressed vocal cords, including preachers, lawyers, and
    Nashville's gospel, pop, and rock singers.
    Preventing hearing loss is a major focus of a multidisciplinary
    program at Michigan State University's School of Music. The school is
    testing the hearing of every faculty member and graduate student in
    music performance, along with percussion and ensemble players, by
    strapping on a device that measures the decibel levels they are
    exposed to in practice sessions and rehearsals. (Students who are
    exposed to excessively loud sounds are urged to practice in larger
    rooms or for shorter durations.)
    "If you're sitting in a jazz band in a small club, right in front of
    the timpani or the horns, it can be hair raising and ear splitting,"
    says James Forger, director of the music school and a professor of
    saxophone. Exposing students to that kind of risk "is simply
    unacceptable."
    The school teaches a seminar in "Healthy Musicianship" and has a
    "wellness team" that includes professors of medicine, biomechanics,
    and music therapy. Team members treat injuries, recommend exercises to
    relieve strain, offer tips for improving posture, and refer students
    to off-campus medical experts, if needed.
    A similar team operates at the University of North Texas. Bernard
    Rubin, a professor of medicine at the university's Health Science
    Center, in Fort Worth, is also a clarinetist and medical director of
    the music and medicine center. He runs a clinic at the university for
    ailing musicians, like the drummer in a local jazz band who recently
    came to him with pain in his lower back and forearms. After watching
    the patient play his drums, Dr. Rubin, an arthritis expert,
    recommended a supportive chair, frequent breaks, weight loss, and
    abdominal exercises to strengthen and support his back. Previously he
    had suggested specific shoulder-strengthening exercises to reduce the
    amount of force the drummer would have to use on his drumsticks.
    Dr. Rubin sometimes finds that his best team-teacher is a cadaver in
    the anatomy lab. "When the music students are learning about
    carpal-tunnel syndrome, we show them the muscles and ligaments and
    tendons on a cadaver," he says. "They see where the nerve comes down
    on the arm and where it goes into the hand and fingers. They get an
    appreciation for where the numbness and tingling might occur and the
    complexity of the anatomy."
    As dean of music at the university, James C. Scott has seen his share
    of injuries that threatened to derail careers. "Violinists and
    pianists, especially, know that if they're going to be successful,
    they're going to have to play six hours a day," he says. He cocks his
    arm and scrunches his neck to hold an imaginary violin. "If you walked
    around like that for six hours or more a day, how long would you last?
    Yet they're staying in these unnatural positions for even longer."
    Teaching students how to relax tense muscles and avoid injuries is
    critical, Mr. Scott says. "People who are passionate about their work
    need to have coping strategies. And they need to know how much
    discomfort is normal and when they need to take a break or see a
    doctor."
    No one knows that better than Leon Fleisher, a world-renowned
    classical pianist whose overworked right hand was crippled nearly 40
    years ago from a neurological disorder called focal dystonia.
    Mr. Fleisher, who teaches piano at the Johns Hopkins University's
    Peabody Institute of Music, continued to dazzle audiences long
    afterward with a left-hand-only repertoire. After trying numerous
    treatments, he finally got relief 10 years ago from Botox injections
    that relaxed the muscles in his right hand and allowed him to resume
    playing with both hands. He says efforts like those at the Texas
    Center for Music and Medicine could encourage young musicians to seek
    help for aches and pains before they become incapacitating injuries.
    "Young people recover from injuries and keep on playing, but as they
    get older it takes longer and longer to bounce back," says Mr.
    Fleisher, now 75.
    "It's a popular mantra for any kind of athlete to say 'play through
    the pain -- no pain, no gain,'" he adds. "Maybe that's true for
    football, but musicians are athletes of the small muscles. Pain is a
    sign that something is wrong and you need to stop."
    Unless, of course, it's all in the name of science. Mr. Adduci has
    inflicted his oboe experiment on three other oboe players, one of whom
    agreed to have his nostril wired for a second session. "Which makes me
    think, it can't be that bad," Mr. Adduci says.