Pain Management For Musicians…
Let’s talk about pain management…
I think we can all agree that in general, nobody likes pain. That said, It is important to recognize that pain is an important feature of our design, where it functions as an early warning signal that something is wrong.
When we feel pain, we make corrections to minimize damage and through this action, reduce the pain response that got our attention in the first place.
Unavoidably, we will all experience pain at some point in our lives and hopefully, we will be able to figure out how to manage it so that we can keep enjoying life to the fullest.
Before we begin, I must state here that the following article is not meant to be diagnostic.
I am in no way, shape, or form giving professional advice or making treatment recommendations. I am sharing my own thoughts based on my own experience. If you are dealing with pain, you should always seek the advice of your health care team first.
The first and most important element here is to recognize or know why you are having symptoms.
Having an accurate diagnosis is absolutely paramount. Sometimes it is easy to figure out; if you start working out at the gym and your arms hurt the next day, you have a pretty good idea of what is going on. On the other hand, if your left arm suddenly starts radiating pain, you might be having a heart attack.
The key here is to make the right decision as to when you need help getting a diagnosis and who to turn to to get all your treatment options explained.
Once you have a diagnosis, you may want to consider alternative options to compliment your treatment plan to find a program that works best for you.
It is important to recognize that sometimes even health professionals have difficulty coming up with a definitive diagnosis, or they can misdiagnose a problem, resulting in a second or third opinion to precisely figure what the problem actually is.
We have all been told that prevention’s the best medicine so it is in our greatest interest to practice the sound habits that help us avoid trauma.
As bass players, good posture is a solid goal both when performing as well as when moving our equipment. I am sure that you have seen some of Dr. Randy Kertz’s videos to this effect and there are many great suggestions to prolong our ability to perform actively.
If you are looking for even more detailed information, Dr. Kertz has two volumes of “The Bassist’s Guide to Injury Management Prevention and Better Health” that you should definitely check out.
In that vein let me share this conversation I recently had with Dr. Kertz on this very topic.
Good life choices are critical in pain prevention.
Staying healthy is a great way to stay comfortable. Good diet, healthy weight, adequate rest, good mental hygiene, and routine health maintenance are a solid start. As we grow older, we also (hopefully) learn how to avoid potentially hazardous activities and become more safety conscientious. I have learned firsthand that we don’t heal as quickly as we used to as we age.
Even though we make the best efforts possible, the pain will occur at some point and we need to be prepared to manage it as best we can so as to remain active and enjoy life.
Let’s start with some basics on pain management.
In western medicine, we have been taught that if we have pain, we take a pill.
There are over-the-counter options such as Ibuprophen, Aspirin, Acetaminophen, and others of the kind. When taken sparingly and for the right reason, these are quite effective. If your doctor suggests, you can even bump up the effectiveness if you combine an NSAID and Acetaminophen, staggering the doses so you take each one about three hours after the other if you want to get the maximum effect possible.
We need to keep in mind that excessive use of these “Over-the-Counter” medications can cause serious problems so never assume that they are totally harmless. As stated previously, you will want to speak directly with your doctor for correct dosages for your particular situation.
The next category would be prescription-strength medications including opiates and synthetic opioids.
These require that a doctor be involved and are also effective in the right circumstances. The catch is that they can be addictive, so if you need to take these, it would be a good idea to discuss how to wean yourself off of them as soon as you can with your doctor’s direction. There are circumstances where long-term pain management is needed and there are specialists for these situations that can go far beyond the scope of your general practitioner.
Let’s now move to some non-pharmacological options I have found to be effective:
Heat therapy works by increasing the circulation to an area, soothing discomfort, and relaxing muscles. It can be applied either dry or wet and if you are needing to use it therapeutically, please look up the best ways to apply it for your particular needs. Every occasion that I have spent some time in a hot tub or a sauna, I emerged feeling very relaxed and markedly better than before I went in.
Cold has the opposite effect of heat as far as circulation goes. It reduces blood flow to an area and is useful in reducing inflammation and swelling that causes pain. You may also have a temporary reduction of nerve activity, hence fewer pain signals being sent out. There are a variety of ways to apply cold ranging from common ice packs or aerosol sprays like Biofreeze to whole-body approaches in a bath or chamber.
Getting cold applied to a traumatized area immediately can help cut down on how much pain you will have over the long term. For example, an icepack on a recently vaccinated muscle significantly cuts down on the overall soreness.
If you plan to use cryotherapy for pain management, make sure you know how you are supposed to apply it and what your expectations are. I witnessed a Pan-American weightlifter miss a lift and wrench his shoulder out of its socket. His coach ran out and sprayed him with a can of coolant but he did not seem to improve much and was still in a lot of pain.
Another over-the-counter approach involves topical agents.
You place them on your skin around the affected area and they might provide enough relief to get you by. As these need to be absorbed through your skin, they are most effective for musculo/skeletal aches. As they can still get into your bloodstream, I would suggest you get the purest quality available and continue to use only as needed trying to keep it at a minimum.
Arnica is a well-known anti-inflammatory and has a solid track record for osteoarthritis and blunt trauma that produces bruises. In homeopathic doses, it is safe and can be found in a plethora of different brands and format preparations. I used Arnica regularly until I discovered CBD.
There has been a literal flood of CBD products in recent years.
I have had excellent results with the Full Spectrum CBD from Extract Labs out of Boulder Colorado. They are very detail-oriented as to the fabrication process and achieving high purity.
In my experience, this product has proven very effective and it has a pleasant aroma and feel. The muscle cream has arnica and menthol in addition to CBD and was great when I was dealing with back pain. The face cream worked well, where you don’t want to use menthol, and has a calming lavender aroma. The 80 gm Loc-Tins they use to package this CBD are a great size and very sturdy, making them a good travel* choice.
Extract Labs has a very generous 50% discount for veterans and active-duty military that is particularly worth mentioning.
A CBD + Menthol foam from Kannaco out of Kansas has worked very well for me. It has a very spreadable consistency and is perfect if you are applying to irregular or larger surfaces.
The smell is nice and clean and not overwhelming. I got a huge amount of relief from this when my neck got stiff after working on a drip-line project in my garden. My improvement was substantial after just one day of use. The 50 ml container is a great size for travel* and would be perfect if you plan to exert yourself as part of your recreational activities or hard labor. I would think that this brand is less vulnerable to warmer temperatures than some of the other CBD products that are salve or ointment.
The CBD strongman, the one with the highest percentage of CBD, comes from Aces Joint Repair out of Portland, Oregon. This rub has over 11% CBD and is formulated for musicians, athletes, and people with very active lifestyles.
It has a very nice consistency and absorbs very quickly into your skin. It exudes a light menthol aroma that is pleasant and not too strong and as a bonus, you get that classic cooling sensation that comes with mentholated products.
I found it to be quite effective on my stiff neck and sore back after a combination of a long practice session and a fence staining project. I did use this one sparingly because of the greater concentration and a little bit goes a long way. They package it in a 7oz “Paint Can”, a 3.52oz tin, and “Unit Dose “ 1.05 oz travel* packets that will fit perfectly in your gig bag or backpack.
Looking at all of these CBD formats, I have been very impressed with the results as everyone I tried delivered substantial levels of pain relief. They were so effective that they were all I needed to be quite comfortable.
It is worth mentioning that these companies also have other CBD products that may be excellent as well but I have limited my trials to those related to pain relief.
The different ways they deliver the active ingredient would probably be a key factor in selecting which brand to use. Some people may prefer foam over cream and unit does are certainly a great idea for travelers*. It really boils down to personal taste and I can see each being indicated for different circumstances.
One important factor to consider when selecting a CBD product for pain management is chemical purity because you don’t want impurities getting through your skin along with the therapeutic agents. All the products I tried have readily available lab analysis reports for you to review and are very up from about the high quality of their respective products.
*Prior to travel, please check the latest regulations on traveling with CBD, as the rules have been changing.
Hai Tong Pi:
Hai Tong Pi Tang is based on a Chinese traditional herbal formula based on Erythrina and they do have a version with CBD.
This liniment has been used for thousands of years for acute and chronic injury and they claim it supports a healthy inflammatory response. It kind of smells like pancakes and the aroma can be modified if needed. This was recommended for arthritis and joint pain by a friend who has been using it for some time now.
The approach is to microscopically lift the skin to motivate one’s body to heal itself. As this tape is very flexible, it is often worn while the patient is being active. This is perfect if you have identified a problem movement or area and know how to place the tape to get the best results. I think this is particularly useful if you are suffering an injury that stems from repetitive motions that you have been able to identify as the cause of your malady.
Intraoral pain management:
I do want to mention an area that gets overlooked with pain management, sores in the mouth. If you have ever bit yourself, burnt yourself on hot food, or scraped your mouth with a sharp chip or a piece of toast you have likely got an aphthous ulcer (canker sore).
Although annoying, these will usually resolve on their own in 14 days. I have found that rinsing with mouthwash by The Natural Dentist promptly and repetitively can reduce your discomfort but also cut your healing time down in half.
If you have tooth pain, I strongly recommend you see a dentist as soon as possible. There are topical agents and remedies but they don’t address the cause and you don’t want to give things a chance to get out of hand, especially when out on tour! Infections in the head and neck area can be life-threatening so definitive treatment is always the best approach.
Getting help from machines designed for home use or touring musicians may be another good approach for pain management.
Light can treat pain. There have been studies using safe levels of light at the red end of the spectrum to help with joint and muscle pain by reducing inflammation that is very promising. Most of the applications have been for athletes but this modality can work for anyone.
The DNA Vibe is a cutting-edge technological device that uses both red light and near red light wavelengths combined with micro-vibrations and magnetics.
The idea is a resonance with our cells that enhances the reparative nature we already have and by accelerating our healing, there is decreased pain in both intensity and duration.
My wife and I have been personally testing a unit and we have both noticed remarkable improvements so far! I was so impressed that I reached out to DNA Vibe’s Founder and CEO, Perry Kamel, to find out more about the science behind the treatment modality.
Join me in this conversation with Perry:
TENS therapy (Transcutaneous Electrical Nerve Stimulation):
There are home versions of TENS units that you can use to apply an electrical shock to painful areas. The one that I use is the iTENS Wide Blue Wings Muscle Relaxation Device, which works with a smartphone or tablet.
This system is very easy to use for pain management, has preset timer programs for different parts of your body and you can control the level of shocks delivered. The shock level is not too uncomfortable and you are able to decrease it if you feel the need.
Massage and vibration for pain management:
Spending some time in a massage chair can be quite helpful for back and leg pain and for overall relaxation. They are definitely costly and take up space but they can be used routinely in the convenience of your home.
I first tried one of these chairs in a mall in Dallas and decided that I had to get one someday. Many years after, when Sharper Image had storefronts, my wife got me one of these as a gift and I used it daily until it gave up. By then, I was convinced of their value and replacement was a necessity. I have tried more portable versions that you can place on any chair or you hold them in place and I don’t find them to work as well.
Fortunately, Costco carries a variety of these chairs and will deliver them (membership required).
Some smaller more portable versions might bring some relief and are indicated for people on the go.
I have been seeing a lot of therapeutic “Thumpers” being used to help with muscle stiffness and soreness lately. These obviously don’t take up as much space and are best for a targeted approach where you work localized sore spots.
You might need someone to help you reach areas that aren’t readily accessible by yourself.
Full body vibration on a platform can help manage some pain by both building your core muscles and helping to relax them.
In addition, they claim to help improve your balance, muscle tone, and lymph movement.
I do own one and I like to spend 10-30 minutes daily on mine; I add some light dumbbell work and watch TV while I am standing on it.
These platforms have preset programs or you can customize your intensity level to meet your needs. I find these most effective if you use them daily and I notice a big difference if I don’t make time to use mine routinely. I miss mine a lot when I travel but the sheer size is a limiting factor.
In addition to Physicians, you might benefit from alternative health care professionals for pain management. Naturopaths, Physical Therapists, Chiropractors, Acupuncturists, Massage therapists, Reiki masters, Reflexologists, and Energy healers who practice more non-invasive, treatment modalities. These highly trained individuals might possibly provide you with viable options to achieve a reasonable level of comfort.
Pain Management Wrap Up…
I am sure there are a lot of treatment options for pain management that I have not mentioned here only because this topic is extensive and could fill volumes. My main objective is to expose the tip of this iceberg and start the conversation. As a community, I am sure we have a massive amount of knowledge and if we share it, someone out there might benefit.
I would hope that by just addressing the topic, that this article might help someone avoid addiction, unnecessary treatments or surgery and still enjoy a high-quality lifestyle.
Do You Have Trigger Finger? with Dr. Randy Kertz
Play Every Note with Dr. Randy Kertz
Play Every Note…
In this month’s video, we will cover the best approach to practice on your bass fretboard.
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Category: Audio Education Technology
Title: Injury Prevention & Management for Musicians – The Pianist’s Guide
Believe the Hype… Internet Wisdom, with Dr. Randy Kertz
Believe the Hype… Internet Wisdom…
In this month’s video, we will shed some light on Internet wisdom and how to proceed.
Most Injuries Are Self-inflicted… A look Into the Mirror of Bass Player’s Health
When you want to professionally approach your body for playing bass, you will be required to look into the mirror of how you treat yourself… every day.
‘Before you heal someone, ask him if he’s willing to give up the things that make him sick.’- HIPPOCRATES
As artists we often think pain and strain, to some extent, is the measure of our coolness, our rebellion on stage, a measure of growth, the originality and uniqueness of how much your body can withstand without sleeping, hydrating, changing our stage costume that was never comfortable to begin with, etc. However, if we go down that road to outsmart our health, competing band or cooler player than you, it can be a short path very quickly.
Growth and development and pushing ones boundaries, especially on stage, is often simply self-inflicted harm and mistreating the body’s early signals, that something is not serving us. That first sensation of discomfort, burning, tingling, that subjective “somethings off” but, never mind, that subtle moment, we’ve crossed a threshold, because we didn’t listen.
How many times did you sit in a session until your leg went numb? How many hours in an evening did you hold on, not having a single sip of water, cause you ‘have to’ drink a toast with every fan you meet after the show? How many times your headpiece pierced into your scull inflicting an initially dull headache that would after many hours cut circulation, press against sensitive sutures of your scull until it inflicts blurry vision, impaired hearing, dizziness or nausea? How hard did you head-bang, feeling the next day you probably sustained a mild concussion?
These are just some extreme examples of what musicians and bass playing performers put themselves through. For the crowds, for the applause, for recognition or fame. Sacrificing their health, their body and wellbeing. That only accumulates, in our cellular memory, yet cannot continue to regenerate, properly heal and reconstruct.
Most of the time, pain, discomfort or dysbalance the body projects onto you, is your nerve system communicating with you, “Your habits are harming me and my health. I need rest, the position you’re playing in is causing wear and tear, the free stage dives without any warm up or preparation are going to fracture a bone or inflict a decent strain of muscles or ligaments. If you don’t properly hydrate, and drink alcohol instead it’s going to develop and inflammatory state or an infection and heal much much slower than you could”.
Yes, that is you, the touring musician overlooked, ignored, brushed off, numbed with a painkiller or worse, glued with superglue and scotch tape because there is no time for that being on tour, performing, recording, writing under the pressure of a label, management, or the very first fans or followers of a newly established project.
Most of injuries and heath problems, are self-inflicted.
Most are functional and come from self-sabotaging habits that neglect your health, look for quick fixes on the go temporary solution hacks, pain-killers, walk-in massages or dangerous chiropractic manipulation manouvres, 3 hour-long nights with minimum sleep, followed with lots of coffee or energy drinks, open wounded blisters closed with industrial glue. Should I go on with examples? You know who you are.
All of this might seem cool and rebellious, when you’re a teenager, but when you’ve passed a certain age of biological maturity, it all Is just detrimental to your health in the long run, causing chain reactions leading to sickness, injury, burn-out, depression and chronic health problems that take months if not years to treat, and sometimes leave irreversible damage for a surgeon to contemplate on.
If you’re willing to commit and admit how you’ve been treating your body, your instrument of your artistic expression, worse than what it deserves, you are ready to face the mirror.
I’ve developed a special service allowing you work with me individually. The Medical Throne of Wisdom is an exclusive health experience with me, a performing arts medicine expert and Physiotherapist for Rockstars. Find out more here:
Your Elbow Tendonitis Starts at the Pelvis… Welcome to ‘The Matrix’
If I got a dollar for every time I heard a weak muscle needs to be strengthened, I would probably be a millionaire by now. The fact that I’m not (yet) is only my fault, I never asked for the pay-up! Now that’s gonna change.
If you read this article, from now on every time you hear that from a trainer, a doctor, a coach or an uninformed bandmate, you send me a dollar! Kidding! (Not)
But when we think of a muscle being ‘weak’ it has nothing to do with being untrained, giving in, or that the song or chord progression is too complicated at the time for your stamina to sustain. That might be the case, and we’ll get to that later, but in principle any muscle. Flexor Carpus Radialis, Rectus Femoris, or Biceps Brachii, all of them, have 3 stages or states of its functionality. And by functionality, I mean proper ’sources’ to work Normal and be Normal-reactive.
A “weak” or painful muscle is not an untrained muscle.
The normal healthy state of a muscle is called NORMO-reactive, we have also HYPER – which is too much, too much contraction versus relaxation, and HYPO- too little, too little contraction versus relaxation, on a general neurological impulse-based level. Hyper-reactive muscles and Hypo-reactive muscles are understood as dysreactive, and always have a reason for them being so, that should be corrected, enhanced or treated.
A muscle contraction is a chemical reaction that causes the nerve system to fire an impulse that contracts the muscles of your forearm and palm to finger a specific note on the fingerboard. In order to do so we need these 8 parameters to be consistent in your body. HYPO-reactivity (“weak”) can be caused by 1) the lymphatic system, especially in dehydration! 2) crania-sacral system, 3) neuro-vascular, 4) nerve system, spine segment lesion responsible for its respective muscle pair, 5) biochemical imbalance, 6) muscle organ connection 8) structural lesion, the for-mentioned- pelvis.
The pelvis – The Bass(e)
The pelvis is the base foundation of everything. Period. In the human body that is, not universally and philosophically. Just like the drums and bass are the foundation of time within a band or a song, fusing everything together in a mutual drive, beat, tone, and tempo. Well so does the pelvis for your whole body. Now, there are over 365 micro lesions, malpositions, and subluxations of the iliol-sacral complex, but for our purposes, we’re gonna focus on the main 3 types, Category I, II, and III, which are the most common, the most typical yet causing a multitude of issues, including as an indirect relation, your elbow lateral or medial epicondylitis. Often named a golfer or tennis elbow, but having to do very little in fact at all, as these symptoms occur rarely as a result of playing the sport, I know at least one bass player that plays golf in his free time, but we need to focus on a wider population, thousands of bass players around the world, and that’s you.
In my practice it’s often the discussion of what was first, the chicken or the egg, meaning, has the injury occurred first and the pelvis just ‘ran with it’ and went into a functional malposition of the so-called ’twisted pelvis’. Or was it the ’twisted pelvis’, that in result led to the injury? The answer is the latter, on most occasions. As medical professionals, applied anatomists, and biomechanists we do not know why that occurs, some claim, it starts in the womb, being curled up to one side, others claim it’s habitual and our one-side dominant arm and leg that is being taught early on in school, others blame it on bad daily habits, such as sitting on one’s wallet in your back jeans pocket, always tapping with the same foot to the rhythm while playing… We’re not quite sure, what we are sure of, is that it occurs almost in everybody, and is mostly indeed correctable but left untreated causes a vast majority of problems.
A ’twisted pelvis’ is functional to your body like a bass guitar cable halfway plugged into an amp. Might transmit some signal but sure doesn’t do its job nor sounds how you rehearsed it for.
Functionally the pelvis is one of the biggest and strongest complexes of joints when in an asymmetric position leads to a chain reaction disrupting nerve function and impulse transmission, which deregulated the automatic activity of muscles supporting the bone structure, especially the hamstrings, compromising the stability of the pelvis, hip joints, spinal column, everything else just follows. A twisted pelvis in any category, left untreated, causes a slue of complex health problems from tinnitus, to ankle joint subluxation, hearing loss, muscle cramps, tendonitis, lumbar spine pain and so much many others, one book could not simply have space for unless it’s a 6000-page long manuscript. That will in time come in book form from me.
What I can say is, in my 15 years of medical experience as a practitioner, I’ve seen only one symmetrical pelvis In my office, and it was a contemporary dancer.
What’s most tricky about it, a twisted pelvis doesn’t hurt, you don’t feel it, and it is very little you can do to correct it with your willpower, body awareness, or training, which would make things even worse. What you do feel however is a pain-chain compensatory reaction, ending up around your elbow manifesting in pain, tingling, numbness, burning and many other sensations including muscle weakness and disc ordination while playing and in daily function. And that’s just simply the consequential symptom. Not diagnosis.
You can find more information about how to book a session with me as well as Anna’s Activation Method, Physiotherapy for Rockstars and Body Management for bass players seminars and the #NEW ‘Medical Endorsement’ available from Performing Arts Medicine CMT at the links below:
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