Lucas Davis

By EMMA BARTLETT

People love music, but there is little thought about the toll the constant practicing and perfecting of skills that instruments take on the body – especially the hands and upper extremities. Just before the pandemic, Care New England started a hand therapy program at Spaulding Rehabilitation of Kent Hospital which provides hand therapy and education for patients so they can continue doing what they love.

“Studies show that 70 to 80 percent of orchestra musicians have debilitating conditions,” said 

Lucas Davis, MBA, OTR/L and Regional Director of Outpatient Rehabilitation Services at Spaulding Rehabilitation Network for Care New England. 

Davis has 15 years of experience in treating hands. He noted that some instrumentalists are practicing between four and eight hours a day. 

“It takes a toll on the body,” Davis said. 

Symptoms include pain, inflammation and/or numbness in the fingers, which can affect musicians’ practice and quality of life. Davis explained that many people who dedicate their lives to the arts (such as painters and writers) can also experience this problem. He said some people do not come forward about their pain due to thoughts of losing their place in the band.

Davis recommended that individuals experiencing pain first see their doctor to explore care options. If referred for hand therapy there are many treatment options including stretches, manual treatment/massage, heat/ice, athletic taping, splinting, ergonomics, strength and endurance training and patient education on how to maintain healthy habits. Davis said they have two certified hand specialists, Kamir Pabón Smith and Matthew Ricketson, who work alongside the facility’s hand therapists. 

Therapy starts with having individuals bring in their instrument and observe how they’re holding it.

“A lot starts with posture,” Davis said.

He explained that someone practicing four to six hours straight may want to break up their marathon session and, after each hour, pause to reassess posture and stretch. The staff also creates splints to help rest the muscles, tendons and ligaments that need recovery. 

Overuse and repeated trauma injuries call for focusing on strengthening the opposite muscles of the ones being used. This will counterbalance and help with strengthening. 

When asked if there were certain instruments that contributed more so to the toll instruments take on people’s bodies, Davis noted violins. The bow-holding position and awkward position of holding the violin itself can cause tension. 

“That’s one thing we see: static positions create issues,” Davis said.

With all that vibration going into the upper extremities, musicians don’t have a break to let their bodies rest. He cited guitarists and saxophonists as additional musicians who have this problem. 

Not pacing yourself or taking breaks can lead to carpal tunnel (nerve compression in the wrists) and cubital tunnel (nerve compression in the elbows) which cause that numbness and tingling into the hands. 

Hand therapy is very similar to physical therapy with patients coming in for four to six week sessions, with twice a week meetings with the hand therapist. Oftentimes, hand therapists could suggest rest with some light stretching to let the inflammation calm down. 

“We want to give people the techniques of what to do so they can maintain their careers or hobbies,” Davis said.

After four to six weeks if progress hasn’t been made, Davis suggests patients return to their doctor. If the care was effective, they may pursue an additional two or three weeks so the individual has enough tools to work with so they can continue to prevent issues down the road. Davis said you’d be surprised at how you can avoid surgery altogether by splinting and doing the right things in the first few weeks. 

He suspects that not many people want to come forward and think the pain or inflammation will go away. If individuals let it go on for so long, surgery may be the only option. Prevention is key and Davis wants to bring awareness to people having issues so the pain doesn’t affect their quality of life.

This program started just before the pandemic. It has had 12 individuals in its hand therapy program and continues to get the program up and running.