Posted on 6/9/2021
The first week of June has been annually designated by the American Society of Hand Therapists as Hand Therapy Week. It’s a time for raising awareness of hand, wrist, arm, elbow and shoulder injuries and conditions and the therapists who have specialized training to treat them. This week is also a great time to spotlight the individuals who most benefit from hand therapy, individuals like musicians.
Playing a musical instrument is emotionally, mentally and physically demanding. Musicians, like athletes, are at risk for career-ending injuries in the neck, shoulder, wrist and hand. In a musicians’ lifetime, 63-93% will experience musculoskeletal symptoms related to their instrument play. Even the most conscientious musician can begin with symptoms or injury at various times through their play and performance season.
The challenges musicians face are practice and rehearsal patterns established by others (an orchestra conductor, for example) in large segments of time, without rest or stretch breaks. There is also fierce competition for work, and musicians may be reluctant to complain of injury or new symptoms for fear of losing out on an opportunity. Additional injury risk factors include inadequate physical conditioning, poor posture, abrupt increase in play time and patterns, poor techniques or a change in the instrument.
Symptoms, whether intermittent or persistent, are seen most often when learning to play over the age of 50. In professional musicians, symptoms can present when increasing the complexity or time spent playing.
Common symptoms include:
- Muscle cramping
- Inability to control motion
- Stuck, catching or locking joints
- Inability to straighten fingers
Hand therapists have the important skills needed to evaluate musicians and identify abnormal sensation, poor posture and other causes of symptoms.
A therapist identifies risk factors and develops a rehabilitation program specific to the musician’s instrument, goals and play demand. The plan may start with an active rest period, avoiding activities that cause symptoms while mentally rehearsing and initiating new normal movement patterns. During this stage, the therapist modifies the play/practice schedule and explores pain control techniques and strategies including diet, exercise, sleep and posture.
When the active symptoms quiet down, the hand therapist begins the advanced rehabilitation phase with a goal to return to play. The therapist monitors play and rest cycle and a home program is developed to provide visual feedback using imagery and mirrors. The advanced rehabilitation phase also involves aerobics and fitness, strengthening, postural exercises and increased duration and complexity of play.
The hand therapist works with the musician to develop a return to normal play schedule that is timed incrementally. The schedule starts with a slow and easy repertoire and passages, increasing to fast and more challenging passages for up to 10 minutes. Activities that help with return to play include warm-up with brisk walking, cycling and stretching.
The musician will warm-up with their instrument using easy scales, long movements, slow and quiet play. As rehabilitation progresses, 50 minutes is generally the maximum play time before rest is suggested. The therapist also instructs the musician on symptom management techniques during rest and after play. These management techniques include ice, hydration and stretching.
Hand therapists identify the root cause of injury, provide a whole-body approach to care and work in collaboration with music instructors to ensure continuity with proper technique and posture. Education and early intervention is key, as early treatment leads to better outcomes.
If you or a loved one are a musician and suffering from pain or discomfort while playing, request an appointment today and experience the power of hand therapy. Our certified hand therapists will help you get back to doing what you love – creating beautiful music!
By: Rob McClellan, OTR/L, CHT. Rob serves as the hand program coordinator for Physio.
Physio and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.
Posted on 5/25/2021
Have you ever heard the term “mask jaw”? Well, guess what? With a year-plus of everyone wearing masks to protect from covid, it's a thing!
Mask jaw is the jaw pain and pressure many of us experience as we wear our masks for an extended period of time since the start of the COVID-19 pandemic. Now, while the Centers for Disease Control and Prevention recently put out new masking guidance for vaccinated people, masks will still be part of most of our lives for the foreseeable future. And, all that mask wearing can take a toll!
If you jut your chin forward or tense your jaw muscles to hold your mask in its proper position over your nose and mouth, you are likely experiencing jaw tightness. Headaches and muscle tension can also be caused by stress, something we’ve all felt more of since March 2020!
Let’s take a closer look at how your jaw works. Your jaw bone connects to your skull on both sides of your face, and is referred to as the temporomandibular joint, or TMJ. It is a rounded bone, with a disc that provides a cushion to support the joint, much like the discs in your spine and meniscus in your knee.
When you first open your mouth, your jaw hinges and rotates. As you open further, it glides and translates until you open it fully. This action happens with large muscles from your temples and cheek, to smaller muscles deep within the jaw. At least that’s how it works normally. When there is an issue with the disc, the muscles or the joint itself, it is referred to as temporomandibular joint dysfunction, or TMD.
TMD includes a wide range of symptoms, such as pain in the jaw or neck, headaches, locking of the jaw in an open or closed position, clicking noises and pain or difficulty with speaking, eating or chewing. TMD symptoms are widely reported by many people, but become troublesome when they start limiting your day-to-day activities.
Now, let’s dive into how your mask may be the culprit to any lingering jaw pain you may be experiencing.
- Maybe you are breathing through your mouth while wearing your mask. Did you know that this places more stress on the jaw from it being constantly open?
Wearing a mask can feel like you are not getting enough fresh air, but it should not alter how you breathe. Each inhale and exhale should pass in and out of your nose. Your jaw muscles are relaxed in this “resting” position. This means that the tip of your tongue is gently touching the roof of your mouth while your back teeth, the molars, are not quite touching.
If you breathe in and out of your mouth, your jaw remains open. To keep your jaw open means your muscles are doing extra work. When you breathe with a mask on, focus on the air passing in and out of your nose.
- Maybe the ear loops are too tight. This creates tension and can throw off the alignment of your jaw and, in some cases, cause headache.
Masks come in all shapes and sizes, and the fit is important. Whether made of fabric or disposable, it should never feel like it is pulling your ears forward or your chin backward. These compressive forces can easily trigger a headache. Consider a mask extender or “ear savers” to keep the ear loops from tugging and avoid a potential headache altogether.
- Are you clenching your teeth more because of stress? This is an easy trigger for TMJ pain and dysfunction.
Remember the resting jaw position? This is the most relaxed position for the muscles. When you clench your teeth and hold that bite position for extended periods of time, the jaw muscles can go into spasm. Avoid gum chewing or biting your nails, which can make symptoms worse. Exercise is a key component to overall health and managing stress. Take a walk or jog, meditate or find another way to get moving. Your body and your jaw will thank you.
- Chances are, you are moving your jaw in altered positions to adjust how your mask is resting on your face.
With a proper fitting mask, you will avoid overusing your jaw. Use a mask that has some moldable wire that can be shaped around your nose. Additionally, avoid masks that are too big and sag on your face, or that are too small and tug on your ears. You should be able to speak and breath through your mouth (wink, wink) comfortably. To avoid jaw pain, make sure your mask is molded to your face and does not slide or move easily.
If you are feeling pain or clenching in your jaw, experiencing headaches or are having difficulty with chewing or eating, physical therapy can help. To learn more about our TMD program or to schedule an appointment at one of our centers, please contact us today.
By: Nicole Romaine, P.T., MPT. Nicole is a physical therapist for Kessler Rehabilitation Center in West Orange, NJ.
Kessler and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.
- Maybe you are breathing through your mouth while wearing your mask. Did you know that this places more stress on the jaw from it being constantly open?
Posted on 5/12/2021
“Am I Injured?”
This is a question I get asked by many runners.
“How do I know if I’m injured and not just sore from running/training?”
Short of a physical examination, this is what I tell them...
There is good pain and bad pain. Good pain stops when you stop. It is generally mild, diffuses and doesn’t affect quality of movement. Bad pain does not stop when you stop. It can get worse during or after activity. It can be sharp in nature, and significant enough to force you to change your gait whether you realize it or not.
If you have rested or taken time off from running, and the pain has decreased or gone away only to return when you start running again, there is most likely some underlying issue that needs to be addressed. There could be an issue with muscle imbalances, running form, footwear, training schedule, joint mechanics or any combination of these.
If you are taking non-steroidal anti-inflammatory drugs (NSAIDs) daily or after every run for pain, you may have an overuse injury. Overuse injuries account for the majority of running injuries. They occur when a tissue is loaded beyond its threshold. In bone, this can result in a stress fracture. In tendon, this usually manifests as tendonitis or tendinosis. Excessive stress to a ligament can result in a sprain.
Overuse is relative and not always obvious. It can be a result of “too much, too soon” with regard to training or mileage. It can also be due to cumulative stress from non-running activities and/or compensation. When a structure takes on additional stress to unload another, it can break down.
How can physical therapy help? A thorough evaluation by a physical therapist can help identify the underlying problem so that you’re not just treating symptoms.
A progressive loading program can assist the injured tissue regain the strength needed to resume running and training. Hands-on therapy can also help restore normal joint mechanics so that muscles are functioning more efficiently and inert structures are not unnecessarily stressed.
Physical therapy can you build strength, endurance and minimize running injuries, so you can achieve your personal best.
By: Martine Marino, MPT, COMT. Martine is a physical therapist and the center manager for NovaCare Rehabilitation in Bethel Park, PA.
NovaCare and Select Physical Therapy are part of the Select Medical Outpatient Division family of brands.
Posted on 4/19/2021
While it is America’s favorite pastime, baseball is known for being a slower paced and long duration sport that can place strain on the body. Although this sport is typically low in intensity, it can lead to overuse injuries due to the repetitive motion of it. A pitcher can typically throw more than 100 pitches a game.1 Now imagine doing that 65+ games a season; that’s a total of more than 6,500 pitches in a year. This volume can lead to multiple injuries in pitchers. Additionally, position players combine the volume and intensity of throws with hitting and base running. So, although baseball may seem like a simple game, the different components can take a toll on the body.
Some of the most common injuries in baseball include both upper and lower body injuries.2, 3 They include:
Rotator cuff tears
Rotator cuff tears are common in baseball players, especially players who perform repetitive, high intensity throwing motions, such as pitchers. The rotator cuff is made up of four muscles that work together to help to rotate your shoulder and arm away from and toward the body. The act of pitching over and over can wear down the structures attached to these four muscles, leading to a break down in the long run. This then leads to the muscle tearing. If found fast enough before the tear, this injury can be helped with a licensed physical therapist. However, if the muscle is fully torn surgery will likely be needed.
The UCL is the ulnar collateral ligament in the elbow; more commonly known as the Tommy John ligament. The volume of throwing in baseball players can cause added stress on the bones and tissues of the elbow and this repeated motion can lead to injures and even full and partial tears of this structure. In some cases, this injury can cause a pins and needles feeling in the ring and pinky finger, causing an athlete to not be able to grip a ball. Most cases can be fixed with rest and physical therapy; however, some cases may require surgery.
The labrum is a structure in the shoulder that helps keep the shoulder socket tight. A tear is caused by the overuse nature of baseball. This injury typically appears as the shoulder joint locking up or with weakness of the shoulder. A labral tear is typically spotted by a doctor and can be either repaired surgically or with physical therapy and rest.
Knee injuries, although less common than other higher intensity sports, are still possible in baseball. Injury normally occurs during base running. The sudden stopping, sliding and quick changes in direction can cause an athlete’s knee to give out, leading to a sprain or tear of the MCL or ACL. Injury to these ligaments typically appear with sudden pain and the sensation of popping or snapping inside the knee. Similar to UCL injuries, an ACL or MCL injury can often be fixed with physical therapy and rest. However, if the ligament is fully torn surgery is usually required.
Muscle sprain and strains
Like many other baseball injuries, muscle sprains and strains are usually due to overuse. In baseball, these types of injuries are common in the legs, arms and back. Symptoms for sprains and strains will vary based on the person and the seriousness of the injury. Typical symptoms include pain, weakness and muscle spasms, but they may also include bruising and swelling. These injuries rarely require surgery and can typically be solved with physical therapy and RICE (rest, ice, compression and elevation).
With all injuries, a common theme is that working with a physical therapist can help for healing and strengthening both pre- and post-surgical intervention if necessary. If you have been injury, please request an injury screen at one of our convenient locations. With a guided treatment and exercise plan by a licensed physical therapist, you can be back to your sport in no time.