After Surgery: All the machines!

So I know that this surgery stuff doesn't really seem relevant for MUSICIAN'S health,but since heart disease is one of the major issues for everybody, maybe it can help a musician or two. Just so many things I learned through this process, such as a DNR does not "expire", you need to ask your surgeon what size valve they are putting in, little things that wouldn't have occurred to me prior to this experience. And of course, one thinks that if the surgery is a success, then all is well. Not always the case. A successful surgery can actually cause other things to happen which can lead to unanticipated problems.

So here we are and the doctors have decided that Mom needs to be reintubated. At that point, she just needed help with breathing. But then a number of things happened. First, the heart muscle went into shock. The part of the heart that had been deprived of blood when the valve was so small, was now receiving the appropriate blood flow. It was not used to this and this sent the "healthy" side of her heart into shock. So a balloon pump went in to support that side (the left) of the heart. Next the kidneys started to fail. By this time she was unconscious and showing signs of edema or fluid retention. Her body was swelling, and she wasn't processing liquids. It was at this point that I actually arrived in the States, having been out of the country teaching prior. The doctors used the term "multi organ failure" when I was speaking to them, and I got the next available plane back to Miami. When I saw her in the Surgical ICU unit, she was unrecognizable. Her body was swollen, she was unconscious, and every machine available was plugged in to her, except dialysis. That was added the next day. She was unresponsive and it really did not look good. To add to that, I couldn't enter the room, having come down with a cold on the plane. I could wear a mask and sit outside the door and call to her. So that is what we did. My sister and I were at the hospital almost 24 hours a day, talking, singing, reading and connecting with her. We were also very present with the doctors and the nurses. Everything that was done, we discussed with each other and with them. The only problem was when we were discussing her DNR, signed in 1995. We were told by one doctor that it had "expired". This doesn't happen. For the record, unless it is rescinded by the person who originally filed it, a DNR stays in effect. Fortunately we did not need to implement it. After the dialysis started, her situation began to improve. One by one, the machines were removed, beginning with the dialysis machine. Then the aortic pump was removed, then other apparatus, until we were left with the ventilator. I informed the doctors and nurses, that they had better make sure it was the correct time to take her off the ventilator, because it wasn't going back, so they were aware of necessity of making sure that they didn't do it too early. And when it finally came out, we were on the way. But there were still a number of hurdles to overcome. Next: ICU psychosis (who knew?)

The Surgery and Beyond

So the surgery to replace Mom’s heart valve was supposed to be a minimally invasive procedure where they would make an incision between the ribs and replace the valve without having to crack the breastbone etc. Needless to say, this is NOT what happened. It turned out that the blood vessels surrounding the valve had grown too calcified to allow for this type of procedure. Additionally, because the original valve was too small, the space into which the valve needed to be inserted was not sufficient. This was not determined until after they had opened up the chest. At this point another series of bypasses were required in order to create room for the new mechanical valve that they wanted to put in. So all of a sudden we went from a minimally invasive 1 procedure surgery to an open chest with multiple procedures required. The surgery also took considerably longer than originally anticipated. All of this made the outlook for recovery less than optimal.

While in surgery, of course she was intubated, a machine was substituting for her heart and her body temperature was lowered to minimize the risk of damage to the brain. In the recovery room, she remained intubated as they slowly warmed the body and began to try to bring her back to consciousness. The goal is to remove the breathing tube and other machines as soon as possible and get the patient up and running fairly quickly. This actually increases the chances of a full recovery. It also is the only way to assess whether there has been any loss of brain function. Only when the patient is conscious and can respond to stimuli and questions can their mental status be evaluated. By the second day, they had removed the ventilator. Unfortunately she wasn’t responding as they had hoped. She seemed disoriented, in a lot of pain, and really not recognizing her surroundings. Now here’s the thing. Mom has a DNR. The hospital was fully aware of the DNR, it was in her file etc. However, one thing to remember, is that when a procedure is performed in support of another surgical procedure, it may not be subject to(nor should it be subject to) the restrictions that come with the DNR. If she had had a heart attack and entered the hospital with a DNR, they would not have intubated her nor performed any extraordinary life saving procedures, including ventilators etc. But this is a different set of circumstances. She agreed to the surgery, so she agreed to the supportive care following the surgery. Therefore, if reintubation is needed that can and possibly should be done. This is exactly what happened. The plan was to reintubate and then support her through the next couple of days until she was stronger and began breathing on her own. Unfortunately things went from bad to worse at this point.

Next: All the machines!

About that Heart Valve.....

Okay so here's the thing. This may not be a "musician" issue, but it is one we all should know about. The first thing is if you need to get a heart valve replaced, make sure you ask what size they are putting in. Things you didn't know you needed to know right? And for an adult it should "never be less than a 21". The quote is from a cardiologist at Mt. Sinai hospital in Miami. Also just a point of preference here. If they are putting in a porcine (pig) valve, know that it will last tops 10 to 15 years. So it is sort of like planned obsolesence. If they give you a porcine valve, they don't expect you to live longer than that or they expect you to have another incredibly complicated risky surgery later in life. So how do I know these things? Well, Mom had a heart valve replaced in 2003, along with a triple bypass. A porcine valve. Almost immediately, her cardiologist said that he was noticing stenosis in the valve. He said that we should plan on another surgery in the relatively near future. Needless to say, Mom was not particularly enthusiastic about the prospect. At this point, we started alternative treatments, acupuncture, herbs and energetic healing techniques to try to avoid this. She did very well with this and the stenosis was controlled, it didn't get any worse. When she moved in with us, we kind of let that therapy lapse, new routine and all and then all of a sudden she got dizzy one day. Two days later, she is in the hospital, being prepped for a replacement of the same valve that had been replaced not 7 years earlier. But now she is older, the blood vessels have calcified more and the surgery is just more difficult. To a man, every doctor consulted stated that her original replacement valve was just "too small". The bypasses were working wonderfully, but the valve was not working well at all. So here we were again, but now she is 7 years older and the surgery is risker the second time anyway. But we went for it because the really was no alternative. There are no drugs to treat a heart valve that is slowly closing and at this point it is really a sort of "pipe" problem. When you are in your 80s, one fall from a dizzy spell brought on by the blood not being pumped through the heart can be a life threatening experience. And there was no way to tell when it would happen again, no warning signs or anything to give one a chance to sit down and wait it out. So here we were.

That's the thing about this sort of condition. One day you are going about your business, the next day, in the hospital, prepping for major surgery. Signing all those DNRs, consent for treatment, surrogate etc. forms. And it seems as if you have no control over your life. The doctors just tell you what you need. They don't offer you options, they just say things like "we'll come in the morning and bring you down for your pre-surgical tests". "NO getting out of bed without the nurse". For an active independent person, it is a humbling and overwhelming experience.

Next: surgery!

Acupuncture for Musicians

The practice of acupuncture is one of the most ancient healing techniques still in use today. It is part of a larger system of healing known as Traditional Chinese Medicine, or TCM. TCM is based on the theory that a healthy person is in balance, both with himself and nature. Illness is caused by being out of balance or harmony, with either oneself or nature. Chinese medicine views the body as a reflection of the universe. This is consistent with the philosophical basis of this form of healing, the Taoist philosophy. As in Greece, the ancient Chinese healers were also philosophers and based their observations and treatments on the Taoist tradition, which believes in the oneness of all things.
According to Chinese tradition, in order to maintain health, one must strike a balance between the yin and the yang. These are two opposing, yet complementary energies, that are imbued in everything in the universe. Health, in Chinese medicine, is not a state that one arrives in and stays, but rather a constant fluctuation and adjustment process. When our bodies cannot adjust to some influences, either external or internal, then we fall ill. The Chinese medicine tradition views the body as a whole, composed of yin and yang aspects. Organs and systems are either yin or yang, and each yin organ or system has its' complementary yang organ or system. In the Chinese tradition, there is a system of energy that links all the organs and other aspects of the body. This energy is called "qi" or "chi". This energy system is the vital life force for the body. It is invisible. It circulates throughout the body through pathways known as meridians. These are alsoinvisible. These meridians are located throughout the body and connect the entire body, from its surface to deep within the body. For this reason, acupuncture that is performed on the surface of the body can have a profound effect on systems and problems deep within the body.
The existence of this energy system has been scientifically proven. Energy points on the skin have been identified with Kirlian photography, and when a radioactive isotope is injected at an energy point, it will travel on the path or meridian described in TCM. There has been a significant amount of research done into TCM, qi and related disciplines such as Qigong.
The purpose of acupuncture is to restore a balanced flow of qi within the body. There are certain points on the body where the qi may become blocked or excessive. An acupuncturist will insert a very fine needle into a specific point to free the blocked qi or to restore its correct flow. The practitioner may twirl the needle or use a weak electric current sent through the needle to stimulate the point. There is no blood even though the needle does penetrate the skin. The needles are very fine and are inserted in such a way that they slip past blood vessels and nerves. Traditional needles were bamboo, but those most widely in use today are surgical steel. The same acupuncture points can be accessed through pressure or heat, although this last practice is not used widely in the United States. Acupressure, the concept of applying pressure to the acupuncture points, has much in common with shiatsu massage, a technique from Japan, with its' roots in Chinese medicine. (see Shiatsu and acupressure in this paper). Moxibustion, or the application of heat to an acupuncture point, involves placing smoldering herbs over or on the site of the acupuncture point.
The most common use for acupuncture in the Western world is that of pain relief. It has also been used for treating drug addiction, weight loss or gain, nausea from morning sickness or chemotherapy, and smoking. There are few, if any, scientific explanations for how it works, nevertheless, it is known to relieve symptoms of pain for chronic conditions, after and during surgery, childbirth and other conditions. There actually has been a considerable amount of research done, but most of the studies show serious flaws.45
In order to diagnose a particular problem, a traditional acupuncturist would use four techniques. The first is inspection. This means observing the patient. This includes inspections of the tongue and its' coatings, the eyes, the complexion and the excretions of the patient. It also includes listening to the patients voice. The second aspect of diagnosis is listening. This includes listening to the breath, speech and being aware of the odors of the body. The third step is to take a detailed history of the patient. This would not be a medical history in the Western allopathic tradition, but there would be particular questions which the practitioner would ask that would relate specifically to the condition from which the patient was reportedly suffering. The previous observations would help the practitioner direct the questioning. The last step in diagnosis is palpation. This includes a pulse examination. In Chinese medicine there are 29 different types of pulse, each having its' peculiar traits and conditions. It would also include palpation of the body in general and of the acupuncture/acupressure points in particular. Those points at which qi is blocked or out of balance, are frequently tender to the touch. Along with acupuncture, the therapist may prescribe herbs and dietary changes to support the patient.
The article "One Approach to Acumoxa Therapy for Pain Due to Tendinitis of the Hand. Wrist and Forearm" is a technical article that appeared in the American Journal of Acupuncture. Nevertheless, it can give the lay reader an idea of the treatment modality that could be used to treat problems of the wrist and hand with acupuncture. The author mentions that in her practice, this type of pain in the hand and forearm is one of the most common that she treats. She first reviews the Western medical definition of Carpal Tunnel Syndrome. She then explains the problem from the perspective of Traditional Chinese Medicine. (The explanation is technical and will not be understood by most readers.) She then explains the diagnostic technique used in Traditional Chinese Medicine. This could be helpful to the lay reader as it would educate them on what to expect from the practitioner of TCM. The author then goes on to explain the treatment program forthe problem. Again, the explanation is rather technical, but it could give the lay reader an idea of the time frame for treatments, and what to expect. The author also has a section on Self-Care. It is short and comprised of those suggestions that the author uses to support her therapy. The last section of the article is a series of case histories. The author gives one example where treatment was totally successful, one in which it was moderately successful and one that the author found to be a failure. She explains the reasons for the differing rates of success. There is also a table with the success rates, showing that the author has either cured or had great improvement in approximately 68% of her patients. She displays an 18% rate of some improvement. 12.5% of her patients showed no improvement.46 She also briefly refers to surgery in the last section of the paper. She states that while she does not see those patients for whom surgery was a success, those who had surgery and come to her office for treatment, seem to be no better off after the surgery. One of her goals is to help patients possibly avoid surgery. The author also discusses, within the context of the article, some methods that are not covered in this paper. Moxibustion is explained briefly in this paper in the section on acupuncture. The author of the article also details the use of particular herbal preparations.
Acupuncture is mentioned in the following books or materials, reviewed in the Self Care chapter of this paper, as a possible treatment for musicians or others with hand or upper body pain: The Musician as Athlete by Dorothy Bishop (page 81); How to End Your Carpal Tunnel Pain Without Surgery by Kate Montgomery (page 72); Play It Safe by Christine Zaza (page 86): and the website Musical Online: musicians and injuries by Paul Marxhausen (page 92).

Trigger Pont Therapy Work

Out of all the therapies that I researched, this is one of the most promising. It allows the musician or person with the problem to be in charge of their own care, at least for part of it. One of the books referred to below, "The Trigger Point Therapy Workbook" by Claire Davies should in my opinion be on every musicians shelf. It is helpful to have some professional trigger point work done prior to try it on your own, but if that isn't possible, this book can teach anyone how to work their own trigger points out, even the difficult-to-reach ones in the back. This book is available at Borders and online.
Trigger Point Therapy
Trigger point therapy is not a form of massage, nor is it related to acupressure as it may seem at first glance. Trigger point therapy has its' roots in Western medicine and there are studies using diagnostic tools such as microscopes that have been used to observe trigger points. A trigger point is a knot or contraction in the muscle and/or myofascial tissue that keeps a constant tension in the muscle and any muscles or ligaments that are attached to the contracted area. Because of the constant contraction, circulation is reduced, as is the removal of waste products generated by cells and tissues. The area is also deprived of oxygen and nutrients because the circulation is restricted. This in turn causes the muscle to contract even further, creating a cycle of pain that continues to worsen as time passes. The theory of trigger points states that the pain that is felt by the patient, more often than not, is "referred" pain. This means that the pain may appear in one area of the body, while the "trigger" for the pain (the trigger point) is actually in another, seemingly unrelated, area. An example of this might be pain in the wrist or hand that results from a knot in the forearm just below the elbow.
Many chiropractors and massage therapists are now becoming aware of trigger point therapy and are using it in their practices. It is, however, a fairly simple theory and most people can learn to treat themselves. There are trigger points that are located out of reach, (for instance in the back area), but there are tools that have been designed by practitioners of massage that can enable the patient to treat even these areas.
It is the contention of some practitioners of trigger point therapy that much of the pain suffered by people is the result of undiagnosed trigger points. Treatment of myofascial trigger points for the relief of pain is not part of the normal education of doctors. The fascia is the layer of tissue that surrounds the muscle. When there is a prolonged contraction of the muscle, as in the case of a developing trigger point, the fascia becomes hard or tight and inflexible. Although there has been material published regarding this therapy since the mid 1980s, it is still primarily the province of massage therapists and other alternative therapists.
Diagnosis of trigger points is relatively easy. They are extremely painful when palpated or pushed. This may seem to indicate that one should avoid them. The therapy for relief of the pain is just the opposite. The trick, however, is to find the trigger point that relieves the pain that is being experienced. The causes of trigger points are similar to those that cause other muscle problems. One of the most common causes is overuse of particular muscles. This relates specifically to musicians. Those caused by this type of problem tend to recur unless the root cause of the problem is resolved. This may include changing the workstation, taking frequent breaks, or changing position in the performance of any work that requires repetitive motion. Other causes of trigger points can be being overweight, carrying heavy bags, briefcases, babies etc. or, for men, carrying their wallet in their back pocket and sitting on it. Trigger points can also be caused during an accident or fall, when the muscles contract suddenly. Other causes can be injections, surgery, or even a skeletal imbalance, whether genetic (as in one leg shorter than the other) or created through surgery, ill-fitting shoes or other causes. Some trigger points are very persistent and seem to return despite repeated treatments. This is usually because the motion or factor which caused the trigger point in the first place has not been resolved. Other reasons may be that the body is genetically not symmetrical, lack of physical activity which can cause stiff muscles, and repetitive movement. Another cause of trigger points can be poor nutrition. Lack of minerals, such as calcium, iron, magnesium and potassium can negatively impact muscle function. Certain vitamins are also necessary to maintain optimum muscle health. These include the vitamins B1, 6 and 12, vitamin C and folic acid. Lack of these vitamins may be either from inadequate intake or from environmental factors that destroy these vitamins before the body can use them. Some of these influences may be smoking, dieting, pregnancy, alcohol, certain medications including oral contraceptives and antacids.
Treatment of trigger points takes three forms. The first, performed only in a doctor's office, is injection of the trigger point with an anesthetic, usually procaine. This is difficult, because the trigger points can be quite small, and it requires skill on the part of the practitioner. The second method for treating trigger points is called spray and stretch. This involves spraying the skin with a refrigerant that numbs the skin, then stretching the muscle and thus the trigger point. This also requires a doctor or other practitioner to perform. The third method, the only one that can be done by the patient, is massage. The massage must be deep and firm in order be effective. The downside to this method is that because trigger points are, by their nature, very painful to touch, it may be difficult for the patient to apply the requisite amount of pressure in order to release the trigger point. This can be learned, however.
The book The Trigger Point Therapy Workbook is designed for the patient to learn to self-treat this condition. While the author recommends professional massage as the best method to treat trigger points, he postulates that self-treatment has a number of advantages, including being able to treat whenever needed and being able to identify points and pressures accurately. The book has a section on the theory and history of this type of therapy, including some of the common causes of trigger points. There is a chapter on how to perform the massage correctly. Then the book is divided into sections of the body. The author shows which trigger points in which areas of the body create "referred" pain in other areas. There is a section specifically on Carpal Tunnel Syndrome, as well as an entire chapter on pain in the arms and hands. The section on Carpal Tunnel Syndrome is included in this chapter. At the beginning of the chapter, the author provides an easy-to-read chart that details various areas in which pain may be felt, such as the outer elbow or outer forearm. Under each heading there is a list of the trigger points that can be the cause of this pain and the page in the book where one will find out how to locate them. Upon turning to the referred page, one finds an illustration that details where the pain is, the corresponding trigger points and how to massage them. Upon looking at the illustrations of the patterns of pain, one can see that they correspond to many of the problems that are experienced by musicians. On page 107, for instance, the thumb and wrist just above the thumb is shown as the area of pain, while the trigger points that cause this pain are in the upper area of the arm. In the section "Causes", the author states "Oboe, clarinet, and some saxophone players often suffer from chronic pain and numbness in the thumb of their right hand, which has to continuously support the weight of the instrument. Though the thumb itself may seem to be the trouble because that's where the pain is felt, the real problem is in the brachialis muscle which has to stay contracted all the while the instrument is being played. In addition to frequent trigger point massage, a wind player should put the instrument down at every opportunity and let the arm hang at the side, allowing the brachialis to lengthen and relax."42
Just skimming this section and glancing at the illustrations of where pain may occur covers almost all of the conditions experienced by musicians. The author illustrates the trigger points which will relieve pain and other conditions such as numbness and tingling in these areas. The rest of the book covers other areas of the body, such as the lower back, the chest and abdominal areas and the legs and lower extremities. The book is well illustrated, easy to read and explains the theories and techniques in a manner that makes it easy to learn how to perform the treatments. The index is also very helpful. It can direct the reader immediately to the pages which correspond to the particular condition in which they are interested.
The article "Position Paper on Trigger Point Injections", available online at www.dringber.com/tpoint, is an article that is appealing to the medical community to find funding for the study of Trigger Point Therapy. There is one mention of musicians in the article. The article states that cases have been presented at the American Academy of Physical Medicine and Rehabilitation that show that Trigger Point Therapy has been useful in treating focal dystonia, a particularly difficult condition to treat. There is no further reference to the case and it is not included in the bibliography of the article. Nevertheless, because focal dystonia is such a difficult condition to treat, the reference is included in this paper.
The on-line article "About Myotherapy: Bonnie Pruden Myotherapy" is more an advertisement for a particular type of therapy than an objective statement. Nevertheless, the article contains a definition of trigger points and an explanation of the therapy. For this particular style of therapy, the patient must be "cleared" by an allopathic practitioner, thereby eliminating any illness as a cause for the pain. The article has one line about musicians, stating that " For athletes and performing artists, relief is usually immediate and followed by enhanced performance".43
The book Performing Arts Medicine mentions trigger point therapy in the chapter entitled "Therapeutic Management of Instrumental Musicians". This book points out that while this must be considered as a potential cause of pain in the musician, most practitioners are not trained in the recognition and treatment of these trigger points. The section on this aspect of treatment covers how to diagnose and treat this condition. The authors also state that "There are no radiographic or laboratory findings in MPS (myofascial pain)."44 The authors also include the clinical characteristics of trigger points. These authors recommend as treatment massage, compression of the point, electrotherapy, cold spray and stretch, and as a last resort, injections.
In the chapter titled Self Care, the following material either recommends or mentions trigger point therapy: Shoulder, Upper Back and Neck: Free Yourself from Pain (page 69 ) and Carpal Tunnel Syndrome: How to Relieve and Prevent Wrist Burnout (page 71) both by Rosemary Atencio, recommend trigger point therapy; Susan Weiss in The Anatomy Book for Musicians (page 74) recommends trigger point therapy; Play It Safe (page 86) by Christine Zaza, recommends trigger point therapy ; and the website Musicians and Injuries (page 92) by Paul Marxhausen recommends trigger point therapy.

Visualization Technique for Your Best Performance

Well it has been a while since my last post. I wanted to post something USEFUL, rather than just informational. I have taught this to kids as young as 10 and they really liked it. It works with older performers as well. Actually this technique can be used to prepare for any type of performance not just a musical one. The trick is to really visualize oneself in the exercise and allow your mind to assist you. If you tend to have certain bad habits performing, add those in to your visualization and make it your own personal script. Good luck and enjoy. Let me know how it goes, those of you who do try it!

Visualization Technique for Peak Performance

Adapted from that of Dr. Konefal from CAM at the Miller School of Medicine University of Miami

1. Sit in a comfortable chair and relax. Imagine a screen in front of you at a comfortable distance with all the knobs you need to adjust color, sound, clarity etc.

2. Imagine yourself on the screen either getting ready to perform or performing.

What would you change or tweak to improve your performance?
Are you sitting or standing the way you want?
Are you holding tension in your body where you should be relaxed?
Are your shoulders creeping upward when you want them settled into your shoulder sockets?
How does your playing sound? What would you change? Rate? Volume? Ease of fingering? Breath?

3. Are you connecting with the audience? If not, imagine the connection from your sense of self in the image, through your body, into your instrument, out across space and reaching the audience.

4. Make any other adjustments until you are pleased with your playing.

5. Bring the image of yourself on the screen into yourself sitting relaxed in your chair.

6. Check to make sure this feels good.

7. If you need to make any other corrections to your playing, put the image back on the screen and make the corrections. Then.,, bring the image with the additional corrections inside.

8. Check again.

Eastern Massage for Musicians

Eastern Massage - Traditions and Practice
Eastern bodywork traditions are based on ideas about how the body functions that are somewhat different from that of Western massage. In general, Eastern bodywork therapies are based on the idea that the body contains energy. This energy flows through the body along certain pathways. The energy and the pathways may have different names in different types of therapies, but the theory behind the therapies is the same. These types of therapy purport to either strengthen energy flow or to restore energy flow where it has been blocked. Most of these therapies do not claim to be "cures" in the traditional sense. Rather, these therapies focus on enhancing the quality of life. Most of these therapies are presented as therapies designed to complement other therapies, be they traditional or alternative.

Shiatsu
Shiatsu is a Japanese form of massage that has its' roots in Chinese medicine. The practice of Shiatsu combines traditional massage with acupuncture. Through this therapy, the practitioner seeks to restore the body's energy balance. The energy, or "qi" as it is called, flows through the body on pathways known as meridians. There are points along these meridians where the qi will gather. If there is tension, injury or illness, these points can become blocked and the qi will not flow freely. In Chinese medicine, these sites are called acupuncture points, and they would be treated with needles, moxibustion or possibly cupping. In shiatsu, these points are called tsubos and they are treated with a finger pressure massage. According to Traditional Chinese Medicine the qi comes in two forms, yin and yang. In this tradition, yin is a quiet, deep, female energy, while yang is surface, active and male. Too much or too little of either, throughout the body or in specific sites in the body, can cause illness or injury. In Traditional Chinese Medicine, balance between the two types of qi is obtained through various treatments, herbal preparations, diet and exercise. Shiatsu strives to balance these two types of energy, as well as release blocked energy. The third aim of shiatsu is to bring about balance among the Five Elements. The Five Elements in Chinese medicine are Fire, Earth, Water, Wood and Metal. These are the same elements which make up the universe according to Chinese tradition. The human body, according to Traditional Chinese Medicine, is a microcosm of the universe. Different organs, characteristics and meridians are associated with each element. An imbalance among the Five Elements will result in a weakness within the body, which will leave it more susceptible to disease or injury.
Shiatsu uses gradual, gentle, rhythmic pressure on the tsubos and the meridians to release the qi and balance the various energies. Usually applied with the fingers, this pressure can also be applied with the elbows, hands, and feet. While there may be a feeling of pressure as the muscle releases, there should be no sudden or severe pain. Unlike Western or Swedish massage, the client remains fully clothed and there is no oil used. The treatment will usually take place on the floor or on a very sturdy table. The practitioner will first treat the Hara, which is the area between the pelvis and the ribcage. This is considered to be the seat of the energies in the body. Then the practitioner will move on to treat the meridians and the tsubos with pressure. The practitioner will end the session by returning to the Hara. The client is encouraged to breath deeply throughout the treatment, and pressure is applied during the exhalation period. Some shiatsu pressure points can be stimulated by oneself. There are a number of books that show the various points and will show the reader how to apply pressure.
Shiatsu practitioners do not usually diagnose illness or injury. Shiatsu is used primarily as prevention therapy and does not purport to cure illness. There are certain conditions for which shiatsu may be contraindicated, such as contagious diseases, heart conditions, disorders of the lungs, kidney or liver, cancer and infectious skin diseases. Many massage therapists are trained in several type of massage, shiatsu being one of the more common modalities practiced. Anyone interested in finding a massage therapist who specializes in shiatsu can contact the American Massage Therapy Association.
Acupressure
Acupressure is sometimes confused with shiatsu, but in fact they are two different systems. They operate from the same philosophical basis, but acupressure predates shiatsu. While shiatsu is used primarily as a preventive therapy, acupressure purports to treat specific diseases or conditions. Acupressure is basically the same as acupuncture, but acupressure applies pressure to the points of therapy, while acupuncture uses needles to stimulate the variouspoints. Different practitioners make different claims regarding both acupuncture and acupressure. Some claim that they can cure diseases, combat obesity and improve circulation. Others view them as preventive therapies, while others concentrate on their uses as a methods of relieving pain.
In order to fully understand the theories on which both acupuncture and acupressure are based, one would need to study the entire system of Chinese medicine. This system has a long tradition, well over two thousand years, and is very complex, combining elements of cultural beliefs as well as medicine. Like shiatsu, acupressure is based on the concept of qi, or energy. The purpose of both acupuncture and acupressure is to relieve blockages of qi that occur alongthe meridian. The meridians are channels of qi which flow through the body. When these are blocked, or the flow is not balanced, illness or susceptibility to injury and illness can occur. Pressure applied to acupoints or along the meridians will restore or balance the qi, thus relieving the condition that troubles the patient.
There have been studies on acupressure, some of which have shown it to be effective for pain relief and relief of nausea. Research has also shown acupressure to be effective in treating headaches and chronic backache. 37
While research has shown acupressure to be somewhat effective, it has yet to determine why the treatment is effective. It could simply be the endorphins released by the pressure, or the relaxation from a hands on treatment. In cases of serious disease or injury, acupressure should be used as a complementary therapy, that is one that is used in conjunction with other therapy. Pregnant women and those with open wounds or varicose veins must communicate these conditions to the therapist. To find a therapist in acupressure, one can contact the Acupressure Institute in Berkeley California or the American Oriental Bodywork Association in Syosset New York.38
The book Finger Acupressure: Treatment for Many Common Ailments, has a section on wrist pain. This volume is very succinct. It has a short section at the beginning of the book that explains how to perform the technique. It also has several warnings, explaining those conditions, such as pregnancy or severe cardiac conditions, for which this technique is contraindicated. Then the volume has various conditions listed in alphabetical order and the corresponding acupressure points. Wrist pain is the last entry and one point is indicated for treatment. The book is illustrated with photographs to help the reader locate the acupuncture point.
The book Performing Arts Medicine, edited by Robert Sataloff, Mary Shaheen and Alice Brandfonbrenner mentions the use of both acupressure and shiatsu in the chapter entitled "Therapeutic Management of the Instrumental Musician." There is no explanation, just a brief sentence that state "Muscle energy and acupressure or shiatsu massage are other forms of manipulative treatment used to strengthen weak muscles, stretch tight myofascial structures, and mobilize joint restrictions."39

Lomilomi
Hawaiian Lomilomi massage does not use the Chinese system of meridians, but it was influenced by the Chinese system and is used as a therapy by the Hawaiian people who developed it. There are many components to, and versions of, Lomilomi. The physical component includes different massage techniques that can be compared to those used in Swedish massage, although Lomilomi predates that technique. It should be noted that this is a traditional Hawaiian form of massage and that there was no written language in Hawaii for many years. Therefore, the practice was passed from teacher to student. The practice was outlawed for a period of time prior to the 1970s, due to laws that discriminated against the native Hawaiians and their traditional beliefs and practices. Therefore, it was only kept alive in secret. Not until the 1980s was this practice "discovered" and research and study began to take place.
Lomilomi uses massage strokes, but it also uses herbs, heat, and salt in treatments. There is also a strong spiritual component to traditional Lomilomi. The practitioner must clear all negative thoughts, as these are believed to contribute to physical problems. The goal is that the recipient of the treatment also break all negative connections and relationships and correct wrong thoughts. A traditional Lomilomi practitioner always calls upon a higher power forspiritual guidance. "Lomi-lomi always encompassed body, mind and spirit."40 Lomilomi resembles European massage more than Eastern massage, as the strokes that are used tend to focus on the circulatory systems (blood, lymph and interstitial) rather the meridians. The practitioner uses oil on the skin to aid in the process. Before the session, a healer will pray and center themselves in order to be able to serve "as a conductor of... energy, and direct it into the tissue or body part that seems blocked or is in a state of distress."41 The recipient is also expected to try to get into the "proper state of mind." There are exercises that the patient can do to assist in this process.
When the session begins, the practitioner "assesses" the patient. The practitioner uses the art of haha (to feel or palpate) to assess or diagnose the patient. After identifying the problem, the practitioner concentrates on the healing process and the desired result. There is no one set routine for lomilomi. Each practitioner develops his or her own style. There are certain strokes and techniques that are used, though the application may differ from practitioner to practitioner. These strokes have traditional names from the Hawaiian language. Many of these are similar to the strokes used in Swedish massage. The Hawaiian name and the Swedish equivalent will be included where applicable. If no comparison is appropriate, there will be a short description.
kahi - comparable to "therapeutic touch" or light efflurage
opa - kneading
kupele - comparable to petrissage
kaomi - pressing down - also used to indicate compressed thought
lomilomi - the tissue is moved in every possible direction
la'au kahea - breathing life or mana (energy ) into the person
hamo - to anoint with oil
The patient may also do an internal cleansing, eating a diet of high fiber fruit to cleanse the small and large intestine, followed by a drink of diluted sea water to complete the cleansing. The practitioner may also employ the use of hot stones wrapped in leaves placed on areas of the body, or the use of sticks that are curved to massage areas. The practitioner may also use ho'upu'upu, which is the implantation of a positive thought or idea, before, during, and after the physical treatment. There are also various herbal remedies, using plants native to Hawaii, that are used by Lomilomi practitioner. These could be taken internally are applied externally, as with a poultice.
The book Hawaiian Lomilomi: Big Island Massage, is an excellent introduction to the practice of lomilomi. While making no reference to any of the conditions that trouble musicians, it explains the techniques and has photos which illustrate the various strokes used in the practice. It also addresses the spiritual component of the practice. There is an interview with a lomilomi practitioner in the appendix of the paper, and in that interview the therapist addresses some of the problems experienced by musicians. With that information, this book takes on a greater significance.
Massage and acupressure are recommended in more books that are written specifically for musicians than any other form of therapy. They are also recommended frequently in other books that have a program of self care that is not necessarily directed specifically to the musician. In the chapter titled Self Care, the following material either recommends or mentions one or both of the therapies: Shoulder, Upper Back and Neck: Free Yourself from Pain (page 69 ) and Carpal Tunnel Syndrome: How to Relieve and Prevent Wrist Burnout (page 71) both by Rosemary Atencio, recommend massage and acupressure; How to End Your Carpal Tunnel Pain Without Surgery (page 72) by Kate Montgomery recommends massage and acupressure; Susan Weiss in The Anatomy Book for Musicians (page 74) recommends massage; The Musician as Athlete (page 81) recommends massage; Play It Safe (page 86) by Christine Zaza recommends massage; and the website Musicians and Injuries (page 92) by Paul Marxhausen recommends massage. Lomilomi massage is listed by Dr. Wynn Steinsnyder as one of the massage therapies that can be useful for musicians. (see appendix for interview with Dr. Steinsnyder and a Lomilomi practitioner.)

Western Massage for Musicians

Okay I said I would post about Western massage several posts ago. I got a bit distracted, but I am back on track! Here it is! I hope it is helpful. There are a number of places where you can try out a massage. Many malls have a chair massage station where there will be therapists that will give you a massage lasting from 10 to 30 minute. These are done without the oils and while the client is fully clothed. It is a good way to see if massage can help your condition without too much commitment. If someone has a specific condition, it is very important to find an experienced therapist who can work specifically with that condition.

Western Massage - Tradition and Practice
There are a number of physical and psychological effects that are obtained from Western styles of massage. Overworked, tense or strained muscles produce lactic acid. This and other waste products can accumulate in the muscles. This, in turn, can produce stiffness, soreness and even muscle spasms. Massage can improve the circulation in the area, increasing the removal of waste products from the muscles. Improvement in circulation also increases the flow of oxygen and other nutrients to the muscles, helping them heal faster. It also stimulates the lymphatic system, which is the body's waste removal system. This also causes waste matter to be removed more quickly. Massage also is useful in relaxing tight, constricted muscles. Muscles that are tight, constricted or in spasm, can restrict blood flow, or they may entrap nerves, causing a cycle of increasing pain. Nerve entrapment causes pain, which causes the muscles to constrict which causes more pain, creating a cycle of pain. Massage is very useful for this type of condition. There are also a number of psychological benefits associated with massage. Massage has been shown to reduce stress and tension in the client. Stress and tension are common problems among musicians and can exacerbate any physical condition that is affecting the ability to play. This, of course, is another cyclical problem. Stress causes muscle tension, which causes pain, which affects the ability to perform or practice, which in turn causes more stress, creating a cycle of increasing stress. Therefore, as a stress reducer, massage can be invaluable for the performer.
Western types of massage use specific manipulative techniques to move or affect the various muscles, the ligaments, the cardiovascular system and the lymphatic system. The most common type of Western massage is Swedish massage. This therapy was developed by a nineteenth century Swedish physician, Per Henrik Ling. He developed his technique using ideas based on gymnastics, physiology, and a study of techniques from Egypt, China, Greece and Rome. Swedish massage uses five different types of strokes. The first, efflurage, is a long gliding stroke done with the thumb or with the entire hand. Petrissage utilizes compression and kneading motions. Friction is a penetrating movement in which deep circles are made into the muscles of the recipient. The therapist uses the thumb or fingertips for this motion. Vibration uses rapid, very confined shaking movements, and tapotement is a series of "taps" performed very quickly in succession. All techniques may not be used in a session. The therapist will use those strokes that benefit the client. They will also communicate with the client and find which strokes they prefer.
Many times, massage is performed in conjunction with aromatherapy. The therapist will use a scented oil and/or there may be an oil diffuser present that scents the room. This is not simply for ambiance. Certain essential oils (derived from plants, not synthetics) have been shown to reduce or enhance brain-wave activity and even to have an analgesic effect.34 These include lavender, lemongrass, rosemary and juniper. The therapist will take into consideration the condition of the client, as well as their preferences when using particular oils.
Massage therapists do not usually diagnose a client. If the client is referred by another practitioner, then the therapist has a diagnosis that comes with the referral. If the client is self-referred, then the therapist will ask certain questions in order to understand what it is that the client is seeking. There are certain conditions which require particular forms of massage. Carpal Tunnel Syndrome is one such condition. This will be addressed later in this section. There are also certain conditions in which massage is contraindicated. Among these are a history of blood clots in the legs (phlebitis), fever, malignancy, or jaundice. Other conditions, such as varicose veins, bruises, burns and rashes or a recent injury require that direct massage over these areas be avoided. While massage is used as a stress reducer in patients with cancer, it should only be done with a referral from a physician and with a therapist who is familiar with this type of treatment. Massage can be very useful for stress reduction and pain relief during pregnancy and labor, but pregnant women should consult their doctor and make sure that they inform the massage therapist of their condition before receiving a massage. Massage has been known to cause contractions. From the above information, one can ascertain that it is very important to have a licensed massage therapist and that the client communicate fully with the massage therapist regarding any health issues.
In a typical Western or Swedish massage, the client is fully or partially disrobed. The therapist will have communicated with the client before beginning the session regarding any injuries or conditions that the therapist may need to know about. Only the part of the body that is being massaged is exposed. The rest is covered with a towel. The therapist will continue to communicate with the client throughout the session, particularly the first session, in order to ascertain which strokes the client prefers and how hard the therapist can massage. The room should be warm, as this will help the client relax and make the muscles more receptive to the massage. The frequency of the treatment may vary. If the treatment has been prescribed by another professional for an acute condition, it may be as frequent as three times a week. If it is initiated by the client, the frequency may range from once or twice a week to once a month. Those interested in finding a licensed massage therapist in their area can contact the American Massage Therapy Association.
There is a vast amount of literature regarding massage and body work. The paper will review that which deals specifically with wind players, musicians and/or the specific problems which wind players may experience.
The article "How to Relieve Carpal Tunnel Syndrome" in the Massage Therapy Journal is written mainly for the massage therapist. It gives the definition of Carpal Tunnel Syndrome from the Merck Manual as "Carpal Tunnel Syndrome is caused by deposition of mucinous ground substance in the ligaments around the wrist and ankle, producing nerve compression".35 This definition may help the patient as may the description of how Carpal Tunnel Syndrome happens that follows. The author explains the physiological process of the condition and the treatment. He uses analogies that the layperson can understand, which is helpful, since some medical texts can be difficult to follow. The author then goes on to explain the system of massage for Carpal Tunnel Syndrome. Again, this is an article for massage therapists, so it is somewhat technical. Nevertheless, it is good for the patient to know what type of treatment they should be receiving. The massage treatment for Carpal Tunnel Syndrome differs from that of other conditions in that it requires a light touch that moves the lymphatic fluid, rather than a heavier touch designed to relieve muscle spasm. The article also includes instruction for self-massage for the same condition, but again it may be somewhat technical in nature. The article is important in that it demonstrates the need for a correct diagnosis of Carpal Tunnel Syndrome, not just a guess. As these conditions can be difficult to diagnose, it is important that the patient be persistent in the search for a name for the condition from which they suffer. Carpal Tunnel Syndrome is over diagnosed, according to many specialists, therefore the second opinion is of paramount importance. The thrust of the information in the article is that a massage for Carpal Tunnel Syndrome will not harm the patient even if the problem is ultimately diagnosed as something else. On the other hand, a massage that is performed on a patient who has Carpal Tunnel Syndrome and is unaware of the condition or does not communicate this to the therapist, can have the opposite effect.
Massage is briefly mentioned in the book The Musician's Survival Manual: a Guide to Preventing and Treating Injuries in the Instrumentalist by Richard Norris, MD.. He states "Massage is useful in stimulating blood flow, reducing edema, and breaking up localized areas of muscle spasm known as trigger points. Massage is also helpful for general relaxation and reduction of overall tension."36
The book Head, Neck and Shoulders Massage: a step-by-step guide is written so that one can learn to massage others or oneself. It also includes visualization techniques that can be used with or without the massage. The author has included different visualization exercises for various ailments or areas of the body. There is a massage and visualization sequence that the author recommends for muscle problems, including Repetitive Strain Injury. The massage indicated would need to be performed by a second person, but the visualization could be used by the patient by themselves. There is also a sequence in the book that teaches the reader how to self-massage the neck, head and shoulders. The book is illustrated with excellent photographs showing the various strokes. The book also informs the reader of those situations in which massage would be contraindicated. Other problems that the book addresses include headaches, migraines, weight loss, circulatory problems and a host of other ailments.
The "Hands On!" website has different articles that discuss different aspects of flute playing. The article "Pain Management Using Massage Therapy" discusses several types of massage that can be used to relieve pain resulting from soft tissue injuries. One type is "cross fiber friction." Another is trigger point massage. The article also mentions the Alexander Technique and the Feldenkrais Method as avenues for the musician struggling with painful hands. Most importantly, the article suggests a team approach to therapy, utilizing physical therapists, a massage therapist as well as the two approaches mentioned above.

Yes It Took That Long!

Okay so it has been almost 3 months since the car accident, and it is only now that I am beginning to feel almost back to normal. Although it was a relatively minor accident, with less than $5000 damage, because I saw it coming and braced for the impact I actually was more injured than if I had not seen it coming. Here is a list of the therapies I have been getting: chiropractic care, (adjustments, TENS stimulation, heat and trigger point work) Neuro Modulation Technique (an amazing therapy that treats the emotional as well as the physical aspects of the pain), massage and acupuncture. I also was given supplements, Sequoia, to strengthen the legs and hip area, and Ribes Nigram to assist with adrenal depletion and build back emotional and physical strength and endurance. The other thing in my favor was that because it is summer, it is slow, I am not teaching a full schedule and there aren't as many gigs. I was able to rest more than I would have been if this had happened during "the season". The chiropractor is impressed and says I am doing better than most people my age who have an accident of this type. In the last two weeks I have finally been able to conduct a rehearsal without being in pain the next day, play a gig with out being in pain the next day and have a normal practice session where I didn't have to make sure that I stopped and changed position every 15 minutes! I feel so fortunate to have these wonderful therapists to work with. From the beginning, my goal was to get well, not "make money"! I didn't go to a lawyer, I picked the therapists that I knew would heal me rather than ones recommended by a legal professional. If you or someone you know is ever in an accident, healing is the prime point. In Florida, with no-fault insurance your company must pay for your therapies. I was also lucky because I pay a bit more (maybe $15?) to have extra coverage that pays for 100% of the cost of the therapy. It really paid off! Many musicians struggle with health insurance. We just have hospitalization, so I decided to pay the little extra for the full coverage on the car insurance. Everything was done and no one needed to wait for the other party to come through etc.. I am sure that this also made it easier for the therapists to decide to treat me.

As musicians, our bodies are at least 1/2 of the equation. If we hurt, then we cannot play our best. At the very least, the pain distracts us from really concentrating on the music. Accidents happen. Any musician who drives a lot, (that is most of us) runs the risk of this and most of the musicians I know have had some sort auto accident. Some of them never fully recover from these, even if they seem minor at the time. Alternative therapies can provide a wonderful option for traumatic injury. Even if there is a severe injury requiring hospitalization or surgery, alternative therapies can help to support the traditional therapies that may be needed. The interesting thing about alternative therapy is that even as they are treating the injury, other aspects of your health also benefit as they treat the person not just the injury. I strongly recommend them for any one who has had an accident of any kind that inhibits their daily activity. Good luck!

So you had a car accident..........

Okay so it happened, I had a car accident. Other guy's fault, he got the ticket, but it still REALLY impacted my life. Most important for this blog, is how it affected my playing. Well, it is my lower back that is affected and I am surprised at how much this can impact movement and comfort in the upper body. I can't sit for more than 30 minutes without discomfort, so playing 2 hour gigs is no fun. While standing I need to move a bit, to keep things lose. When I do sit, I have to sit in just one position, or the pain gets much worse. And carrying gear? Forget about it! Now you may think"Why would a flutist have to carry gear?" But if you work with a band as I do, there are amps, mic stands, music stands, chairs, all kinds of things that need to be moved. In spite of being 50 years old, I have been able to do all of this stuff with relative ease and without thinking about it. Now all of a sudden I have to really think about it. It has really impacted my teaching as well. In class, I can't move quickly to help a student. I actually got dizzy the other day playing in the upper register for a couple of latin tunes. Turning the head to either side works only for about 3 minutes before it is uncomfortable, so my position to see the conductor or to communicate with other members of the group is currently somewhat challenging.

So the question is, what am I doing about it? Well I am really fortunate to have wonderful practitioners of some amazing types of therapy. The first thing I did, while still on the freeway, was call my acupuncture physician and say I needed to see her asap. I got in to see her the next day, on a Sunday morning, bless her heart. She treated me with acupuncture to relieve the acute symptoms, and some light massage. I had a gig the Saturday night of the accident, 2 hours, and another the next afternoon, also 2 hours. By Monday morning I had had it. My body and my emotions melted down. I was in a lot of pain all through the back, but particularly the low back. Dr. Kaplan did some muscle testing and recommended that I see a chiropractor. Now here comes the interesting part! I called the chiropractor, whom I had never seen before, and started treatment. In the insurance universe, in order to continue seeing Dr. Kaplan, the practitioner who recommended the chiropractor, I had to get a referral from the chiropractor to see the acupuncture physician. Hmmmmmm. Fortunately the chiropractor is so far willing to work with me in this manner.

With the chiropractor, I am getting heat therapy, electro stimulation for the back muscles and of course adjustments. The acupuncture physician is giving me massage acupuncture and she is also using Neuro Modulation Technique. This amazing technique helps support the body's healing process. She has, through this process, eliminated negative emotions stemming from the accident and helped the body get rid of toxins and infectious agents that flared up due to low immunity stemming from the accident. She has used the technique to help the various systems (muscular, nervous, fascial etc.) start to return to their normal state. According to the chiropractor, I am healing very quickly! I credit the use of the different modalities, massage, chiropractic, heat therapy, acupuncture and NMT with this. Finding the right doctor is of crucial importance. It is imperative to find one who will look for what YOU need, not what they do. I will let you all know how it goes!

"Why Improvise?"

Not too long ago, I showed up to a gig that was supposed to be a trio gig for four hours. The other two musicians I was going to be working with worked together a lot. I had bags of music, but when I pulled it out, they both peered at it and muttering things about the light and their glasses, proceeded to name a piece I had never heard of and start to play. With no music. The evening continued in this manner. They played songs that, for the most part I was not familiar with, with no parts, by ear. As a classically trained flutist, there was a time when I would have been totally lost. Now, though, I was able to keep up and play along with what they were doing. The four hours passed relatively quickly and while I was working harder than if I had been reading trio parts, I enjoyed the challenge. We were even complimented several times on our playing!

When I mentioned this job to a friend of mine who plays classical music, she looked at me and said “I could never have done that!” Unfortunately this attitude is all too common among classically trained payers. How did this happen? There was a time when improvisation was not considered out of the ordinary. Indeed in the Classical and Baroque periods, it was just something that musicians did. Now it has become the territory of the jazz or pop player, and classical musicians are frequently too afraid to try or they are not interested in the technique.

That last word is important. Technique. Improvisation is not some amazing talent that one is just born with, although of course there are people who may have more of an aptitude than others. Nevertheless, improvisation is a skill, a technique that can be learned and cultivated. Let’s compare music to language. For that is what it is at it’s heart, a language used to communicate. And what is it that music excels in communicating? Well not facts and figures. It is emotions that music communicates best. Music can communicate feelings and ideas that spoken or written language have difficulty in expressing. And how does it do that? With the elements or components of music, rhythm, pitch, harmony etc..

When a musician reads a piece of music, it is the same in many ways, as an actor reading from a script. The idea (script/piece) originated with the author/composer. All the emotional content is added by the actor. An actor can read a script deadpan, with just the words, or they can add their interpretation of the words to create a unique, individual performance. This is what most classical musicians do. They create a unique, individual work of art by adding their interpretation of the content. In many cases, though, this emotional content has been prescribed to be a certain way for so long, due to “ accepted performance practices” that the opportunity for true creative expression is somewhat limited. Ever since the Romantic period, when composers started notating every nuance of a piece, the opportunity for individual creativity for the classical musician has been somewhat restricted. Even in Baroque and Classical music, where improvisation was an accepted practice in those periods, improvisation is not expected. In many cases, the desire to perform the piece as correct for the period has made it almost impossible to improvise. It is time to incorporate improvisation back into the musical curriculum for ALL music students.

Why is it important to improvise? Let’s revisit the idea that music is a language. If the only way that someone can speak a language is to read it from a prepared script, no one would consider that person fluent in the language. Yet this is accepted by many musicians as standard practice. While it is not necessary that all musicians be able to improvise in the jazz or pop style, the ability to be expressive on one’s instrument with one’s own ideas should be a goal of every musician. An actor may never improvise on stage, yet they “improvise” every day when they talk to people. Perhaps a classically trained musician may never improvise in public, but to be able to just play ideas that come into his/her own head in the privacy of a practice room, or when sitting with other likeminded musicians will only improve one’s ability to be expressive with other types of music. Conversely, there are jazz musicians who do not read music and are stumped when they are given a part. The same case can be made for learning to read music. To be able to read and understand another musician’s musical ideas is also an arguably necessary component of musical fluency! On a purely practical note, musicians who improvise are less likely to encounter PRI’s (Playing Related Injuries) caused by physical tension. Improvisation is recommended as preventive to PRI’s and is also used as a therapy for some PRI’s .

So how does a musician who has never improvised find a way to do so? Well, the first thing is to rethink how we look at our art. Again, returning to the language idea, if we look at how people learn language, we see that children are quite fluent in their language long before they start to understand the structure of it. And children may come to school with certain language “habits” that may need to be corrected in the academic setting, but they are still usually able to communicate effectively even with these “habits”. How does this happen? Well of course, they have been listening to people talk since they first had ears. Musicians listen to music of course, but many of us, especially in the classical world, listen academically, analyzing, looking for mistakes, comparing one performance to another or to our own. Of course it is necessary to do this on one level, but in doing this we may miss the communicative aspect of a performance. As children learn a language, they just mimic what they hear, they don’t analyze. It is only after they mature that they develop their own voice and make conscious choices regarding their way of communicating. As adults we can’t return to this really, but sometimes it is good for us to just sit down and try to mimic someone’s playing. Then try to respond to it! Pick a performance that you like, preferably NOT on your own instrument, and try to copy what they do. Then listen to that same performance over and over, and start trying to respond to the performance. If jazz or popular music doesn’t interest you, then pick a slow movement in a concerto, (again not on YOUR instrument), and try to play the melody with the soloist. Try NOT to use the music. You may be surprised at how much of the melody you may be able anticipate, because if it is a classical or baroque concerto, the melody and harmony follow well-established rules of progression. After you feel comfortable playing the melody, or a section of the melody, try playing something OTHER than the melody. Try to play in the rests, or to do a “call and response” pattern with the melody. You will be surprised at how many ideas come to mind. All classical musicians have a huge “vocabulary” of musical ideas available to them, stored in their memory.

If one is interested in learning to improvise pop or jazz, there are many different methods and books, cds, videos, etc., to help one to learn to do this. But in spite of all these, the best way to learn is to listen, emulate then create. Whether you start out listening and trying to learn Miles Davis solos or Coltrane solos, the idea is the same: listen, copy then create. Many classical musicians rely on their eyes to tell them if they are playing correctly, and in the classical music world this is a necessary and valuable skill. If one is playing a 20th or 21st century piece that does not follow traditional methods of melody and harmony, you have to rely on your eyes because what you hear is so different. In improvisation, the opposite is true. We need to rely on our ears to tell us where to go. When you watch jazz players play, you may see that they close their eyes as they improvise. I know that in my case when I do this, it is to shut out the visual input so I can really concentrate on what I am hearing. Human beings are very visual. When we are trained as classical/orchestral musicians, we learn to rely on the visual at least as much as we rely on the auditory sense. When we improvise, we need to trust/improve our auditory skills so that we can use them not just for the details of the performance (i.e. tuning, dynamics etc.) but for directing the performance itself.

If you are an instructor and you want to help your students learn to improvise, first you must be able to do it yourself of course. After that, it is easy to introduce young students to improvisation. They are not as self conscious as older students might be. One easy way is to initiate a “conversation” with the student. Just play something, a simple phrase and ask them to copy it. Once they are able to do this with ease, have them “answer” your musical idea. They can answer with one note! Then try to get them to “answer” in longer more complex phrases. Anther way is to get them to play something and the instructor copies and then “answers”. By doing this the students develop a musical vocabulary which they can access without having to read. These simple techniques can help a student become confident in their ability to express themselves on their instrument. This will help students overcome their fear of playing without a part.

A class setting can be more challenging, as the students will frequently feel inhibited in front of their peers. In one setting with a flute choir, I was able to get every student to improvise by having all the other students playing the harmony. This was at the college level, so I was able to direct the students to play the root, third, fifth or 7th of the chord that was written, give them a rhythmic pattern to repeat, and then each student had 8 bars to improvise. We went around the room, and even the most reluctant student was able to come up with something to “say” for those 8 bars. For most of these students, this was the first time they had ever improvised. The fact that their peers were busy concentrating on the chord and the pattern made them less self-conscious. Working through the chords also gave the students practice in learning the harmonic progression.

After one has started to improvise, one may naturally become interested in the theory and all the technical aspects of the skill. If someone wants to pursue improvisation as a technique to be used in performance, it becomes necessary to expand the “vocabulary” and other technical aspects of the technique. There are many different ways to do this. But even if one never plans to improvise in public, the practice of improvisation in private will only enhance one’s expressive abilities in any other form of music.

Why Do We Play?

If you are reading this, it probably means you that are a musician or performer of some kind. It may also mean that something has happened that negatively affects your ability to practice your art. Or maybe you are reading this proactively, before something happens. Either way, you are searching for the way to be able to perform your art in the most comfortable and productive way possible. Before you read any further, you need to consider “Why do I have to continue to perform? What is it about music/performance and my life that makes it inconceivable to quit, even if it is causes me physical and/or mental/spiritual pain?” If you have an answer to this question, great! If not, this is something that you should consider very carefully, as the answer can greatly impact the success of any treatment for any condition that you may be experiencing.


There are many reasons why people play music or are performers. Most start because they love the art and feel like they have a form of self-expression open to them. If someone is pursuing music or performance as a career and it is the primary or a significant part of their earning power, there can be many outside forces that can interfere with these pleasurable and positive aspects of the art. It is very important that you continue to find joy and fulfillment in your art. If performing or playing music has become painful in all aspects, mental, spiritual and physical, then it may be time to reassess why you continue.

Music making and/or performing involves a healthy amount of ego. You must be convinced that your contribution, whether as a soloist or in a group, is integral to the performance. If too much ego is involved then a musician/performer will suffer and make others around him or her suffer as well. Too little ego and the person is consumed with fear every time he or she has to perform. This can also lead to obsessive practice which in turn can lead to physical problems. It can also lead to “self-medicating”, using legal or illegal substances, to help “calm the nerves”. Either one of these can be destructive for the performer.

If a person’s’ sole purpose in life is to be the “best” at their art, this too can lead to negative consequences. While wanting to be the best is great in many ways, if it is the sole purpose, it will be a difficult goal to achieve. There will be people who are better than you at various points throughout your career!

As in any career, the music “business” and the “business” of performing any art, can be cut-throat. Competition is built into the system and thick skin and healthy self-esteem are necessary tools for survival. Knowing this and being prepared for it will help performers make decisions about their careers. Maintaining high personal standards of conduct may seem, in some instances, impossible. Nevertheless, by maintaining one’s own personal code of conduct and not being pressured into uncomfortable situations, a performer will be better able to maintain a healthy approach to his/her art form.

The healthiest approach is to be the best that you can be, both as an individual performer and in the way you interact within a group. Be confident in your contribution, but be open to growth, both as a performer and as a human being. By always being open to growth and change, you will be able to approach music in an exciting and creative way that will allow you to perform for the entirety of your life. Know that music and other types of performance are incredibly powerful forces in many people’s lives. A performance, musical or otherwise, can move people to action, for good or ill. It can rally the troops, soothe the soul, calm the baby and incite a riot. My favorite teacher had a plaque in his studio which read “The aim and final reason for all music should be nothing less than the glory of God and the recreation of the spirit” - Johann Sebastian Bach. A Japanese philosopher once said “Art is a weapon for realizing peace. It is also an expression of supreme victory in life. Every drop of sweat shed for the sake of art adds to the river of human peace and culture” – Daisaku Ikeda. By striving to create value with one’s performance, the artist can be proud of his or her contribution to society and achieve a mental and spiritual satisfaction with that contribution. And these two things are key to maintaining one’s physical health and the ability to perform unencumbered.

Why this Blog, Why Now?

Today I want to introduce myself and give you a bit of background into why I set up this blog. I have been playing flute for forty years. In my late teens and twenties I was involved in a series of car accidents. (I have at this point been involved in almost 20 major or minor collisions!) By the time I was 34, I was experiencing pain every time I picked up the instrument, throughout the upper body, the back and in my wrists and hands. At times, it hurt just to breathe. I tried every allopathic treatment available at the time, ultra-sound, hot packs, pain medication that made my stomach bleed, physical therapy, and even at one point visualization. The latter worked but it was time-consuming and required a discipline that I did not have at the time. Out of desperation I started seeing a chiropractor, Dr. Seplow. He asked me if I wanted to just get some pain relief or if I wanted to fix the problem. I said I wanted to fix the problem. It took a while but now I play and practice every day, usually pain-free. And if I do experience pain, I know how to work on myself or who to call to fix the problem. I have worked with some amazing healers, who have shown me amazing results from therapies that I would never have considered trying before this. I have worked with acupuncturists, massage therapists, chiropractors, NMT and NAET practitioners, Bach Flower therapists, herbalists and those trained in homeopathy. All of them have had wonderful things to contribute to the healing process. Each person I worked with was patient with me and my seemingly endless questions. When the time came to do my doctoral work on alternative therapies and wind players, several of them graciously volunteered to be interviewed for my research. My own journey in healing and my observations of the struggles that other performers go through, has inspired me to put this blog together. I hope that it is a useful addition, and that those who read it find hope and useful information in the it.

One of the main reasons for this blog is that most information about musicians/performer’s health is presented by practitioners of a particular type of healing system, i.e. acupuncture, chiropractic care or allopathic doctors. These tend to represent the practitioner’s particular practice as the one that will cure most if not all ills. Every human being is different and what works for one person may not work for another. There will be nothing in the blog that has not had success with someone somewhere. So at the very least there is what is called anecdotal evidence for newer or lesser-known therapies. Also, in spite of the fact that musicians have been getting injured for over at least hundred years (think Robert Schumann!) traditional therapies are not always as effective as one might hope. Traditional physicians are generally not attuned to the special needs of the performing artist. Although this is changing somewhat, rest, immobilization, steroids, injections, pain killers and surgery are usually the options that are offered by allopathic physicians. And there is evidence that these are not always effective or even an option for the musician. Worker’s compensation, retraining or new technology like voice-recognition soft-ware may help the computer programmer, but these are usually not options for the musician or performer either. However, there are a lot of other options available through alternative therapies. I will present these option and how they can help musicians ( and of course anyone else!). Please let me know if any of these have worked (or not worked!) for you. And remember, every person is unique. What works for one person may not work for another. The important thing to remember is that there are lots of options. It may take a while, but if you are struggling with a condition that limits the expression of your art, it is worth it to keep trying until you find what works for you. Every musician/artist is unique and has a wonderful contribution to make. Just never give up! The world needs our contribution!

Wrist/Arm/Hand/Neck/Back Pain?

Okay, so the gig is over and your wrist and hands are aching. You go to bed and think, "It will be better after a good night's sleep". You wake up in the morning and your wrists feel swollen and and you can't hold a cup of coffee without pain. Panic sets in as your imagination runs wild........ No need to panic! First of all this has probably been building up over time. A little stiffness, a little aching, we take some Tylenol and forget about it. This may make the symptoms go away, but it will not solve the underlying cause of the problem. More likely than not, the problem is Repetitive Stress Injury. Even if the symptoms seem to resemble Carpal Tunnel Syndrome, the underlying cause may still be Repetitive Stress Injury, which can cause knots in the muscle that can pinch the nerve, causing symptoms that are almost identical to CTS. Repetitive Stress Injury is caused by repeated motion over time that is confined to a particular muscle group. Hmmm, sounds like just what we musicians do! Now here's the deal: because musicians work with pretty much all the muscles in the upper body, some of these muscle groups, (like in the hands or even the wrist and arms) are composed of relatively small muscles. This makes them even more susceptible to this type of injury. A large muscle, like the thigh muscle, may take quite a bit of punishment before it develops RSI (Repetitive Stress Injury) but smaller muscle groups can develop this condition relatively quickly.

Okay so next is what to do about it. There are a number of options available that can help with this. We will start with the least invasive and most readily available option. If at all possible, get yourself a really good professional massage. This is the first line of defense against this type of injury. Just as sports teams have their massage therapists for all those big muscles groups they use, musicians should have massage therapists for those pesky small muscle groups we use over and over. If you are a student on a college campus, the college health center may offer massage for a reasonable fee. If you live near a massage school, this is a great way to get a massage for a good price. Sometimes, a certain amount of massage therapy will be covered by insurance, you just have to check with your company.
So what is massage?
Massage is used by traditional and alternative practitioners. The practice of massage is one of the oldest forms of therapies for which there is a record. Massage is mentioned in Chinese texts written as early as 2700 BC. The Greeks and Egyptians also show massage in their artwork. Hippocrates referred to massage in his writings in the fifth century BC. Currently, many doctors and physical therapists are beginning to recommend massage as an adjunct to their therapy. It has been recommended for conditions as varied as joint injuries, neck and back pain, arthritis and migraines. Many athletic teams have massage therapists on staff, as do many professional dance companies. Because massage therapists are trained in massage, not medicine, many of them refer to their patients as clients rather than patients. This helps prevent any misunderstanding as to the relationship between the therapist and the client. The Western and Eastern traditions have developed different theories and techniques of massage. The first type of massage that will be addressed in the next post is the Western tradition of massage.

Get Rid of Allergies?

Okay all you musicians! (and non-musicians for that matter!) If you know you have allergies, then you are aware that the symptoms can really make playing a challenge. It doesn't matter if you are a singer, wind player or string player, drummer, rock, classical or hip-hop artist, trying to play with a stuffy nose, watery eyes, coughing, sneezing etc. is no fun. And if you take anti-histamines, trying to perform while sleepy and/or dry-mouth is a challenge as well. At this point I am only referring to seasonal allergies and the symptoms they generate. In a previous blog, I referred to histaminum hydrochloride as a great way to temporarily relieve seasonal allergy symptoms. But you can actually get rid of many if not all of your allergies. There are several ways that can work to relieve allergy symptoms. The first is an alternative technique called "NAET" (Nambudripad's Allergy Elimination Technique) http://www.naet.com/. This particular method involves very strict protocols and avoidance of the allergy causing substances. The second, NMT (Neuro Modulation Technique) relieves allergies with simple muscle testing and a protocol that doesn't involve avoidance. The only catch is that occasionally the allergy may come back and need to be retreated. This may indicate that NAET would be a better treatment method for this particular allergy. I had many allergies and NMT took care of about 90% of them. The other 10% I needed to use NAET to get a lasting result. NMT is quicker and easier, so when it works, it is great. But sometimes you need NAET to create a lasting effect. More information about NMT can be found at http://www.nmt.md/IntroductionToNMT.cfm.

If you want to try getting rid of your allergies on your own (seasonal allergies caused by pollen etc.) you can try eating small amounts of bee pollen. Bee pollen contains minute amounts of allergy causing pollens, so eating small amounts over time can create a kind of "vaccine" like effect, causing the body to adjust to the allergens. By doing this during the non-allergy season you may keep your body from over-reacting when the allergens appear again during the pollen season.

The last method for getting rid of allergies is pretty gross sounding, but those people who have tried it swear by it. And according to some data, it also can relieve some auto-immune disorders such as Crohn's disease. It is to get infected with hookworms. According to the theory, hookworms evolved with human beings. In order to infect their human host, they need to calm the immune system by secreting certain substances. These same substances calm the immune system for other purposes as well, thereby relieving the symptoms of those conditions brought on by an immune system that is overreacting to either it's own body or to foreign substances (like pollen). Okay now, personally I have not tried this one, as I found the NMT and NAET did the trick for me and my family. But those people who have tried this swear by it and say that it has totally transformed their lives. You can find more information on this type of therapy at http://www.healthcentral.com/allergy/c/3989/33077/treatment-hookworms and http://cbs5.com/health/hookworm.treatment.therapy.2.1016319.html

Good luck! IF you do try or have tried any of these methods, let me know how they work for you. Happy allergy free playing!

Allergies and the Musician

Allergies and musicians do NOT mix! Allergies are bad enough, but combine that with trying to make music and you have a recipe for disaster. If it is seasonal allergies, the symptoms, runny nose, coughing, sneezing, itchy eyes, scratchy throat etc., over the counter meds may relieve the symptoms, but the side effects of dry mouth and drowsiness can make it just as challenging to play. There are a number of alternative options to help with allergies. The first line of defense is the homeopathic remedy histaminum hydrochloride. This little beauty can relieve your symptoms for seasonal or pet allergies, without side effects. I carry a tube of 30c ( the strongest available over the counter!) with me always, because if I have a flare-up of allergies, including food allergies, this relieves the symptoms within 5 minutes. It also takes care of swollen lips caused by allergies, which if you play a wind instrument, can be a chop killer! There are also a number of products by Natra-bio, which are formulated for specific allergies, i.e. dust, pets, weeds, etc. These are great too if you know for sure what is causing the allergy. These are homeopathic as well, and work very quickly with no side effects. But wouldn't it be great to get RID of your allergies? This can also be done, but I will talk more about that in the next blog! Happy playing!

Playing Without Pain

Ever had one of those weekends where you played and played your instrument (yay, gigs we're making money!) and by Monday your back ( and maybe the rest of your body!) felt as if it were in a vise grip? And if you were outside and it was cold or windy, it can be even worse! What can we do to make sure we are not making a beeline to the chiropractor's office on Monday? Stretching! This is one of the most important things that a musician can do to prevent injury. We play our instruments for sometimes hours at a time, repeating the same or similar motions, using small muscle groups, and this can lead to injury to those muscle groups. Just like an athlete needs to warm-up and cool down their bodies before and after an event or a practice, musicians should be stretching and releasing tension in their muscles before and after they practice and play. Even on breaks! The most important stretch is the one that pulls the muscles in the opposite direction of the way they are used as you play. So, if you play with your arms in front and up, you should stretch the arms back and down. Just this simple exercise, if done on breaks and before and after you play, can help eliminate a good part of that Monday pain and stiffness! Happy gigging!