Department of Music

The most common movement disorder affecting musical performance is dystonia. Dystonia may be defined as a neurological syndrome characterized by involuntary, sustained, patterned
and often repetitive muscle contractions of opposing muscles, causing twisting movements, abnormal postures, or both.

Initially, dystonia usually presents as a “spasm” or “cramp” during a voluntary action (action dystonia), such as writing (graphospasm or writer's cramp) or some other activity (task-specific dystonia), but as it progresses, it may occur during any activity or even at rest and may spread to adjacent body parts or even to the opposite side of the body (“overflow” or “mirror” dystonia).

Dystonia often starts as “focal dystonia” involving a particular body part such as the eyelids, the larynx, the neck, and the hand. Dystonia affecting musicians may be so specific that the dystonic movements may be present only when playing one instrument but not another or one playing only a certain passage.

Movement disorders, particularly dystonia and tremor, may interfere with particular tasks, sports, and occupations and have been known to prematurely end careers of many professionals, including musicians. Although the most common task-specific movement disorder is graphospasm or writer's cramp, there are many other task-specific dystonias and tremors.

Frequently attributed to repetitive strain injuries, carpal tunnel syndrome, and other diagnoses, many of the problems plaguing instrumental musicians are actually movement disorders (abnormal involuntary spasms or movements) and impaired motor control. Growing recognition and appreciation of these problems have led to an emergence of an important medical specialty known as “industrial music.”

Focal dystonia has plagued musicians for a long time, but most have not been appropriately evaluated or diagnosed, and others have denied its presence or refuse to acknowledge the condition, partly for fear that they would have to give up performing. The disorder remained unrecognized or a secret among professional musicians until the 1980s, when two famous American pianists, Gary Graffman and Leon Fleisher, acknowledged their motor difficulties.

Their public disclosure spawned increased interest among other musicians and stimulated research into the mechanisms and treatment of musician's dystonia. Despite growing awareness of movement disorders among musicians, many continue to be misdiagnosed and have stopped playing because therapies have failed to relieve their symptoms. Therefore, it is essential for music teachers, students, parents, and physicians to learn about musician's dystonia and other medical problems of musicians in order to correct improper technique, institute appropriate therapies as soon as possible, and prevent potential tragic consequences.

Overuse injuries and nerve compression injuries — such as cubital tunnel syndrome and carpal tunnel syndrome – are common amongst high-level musicians, and can often be seen in musicians who may not play as regularly, but have poor technique. Overuse conditions of the upper extremities are also typical of musicians who play string instruments due to awkward positioning that they may sustain for hours. Treatment can involve everything from rest and icing, medications, and even surgery.

One of the most important strategies for avoiding injuries—and overuse injuries in particular—is for musicians and their families to recognize when it’s time to take a break from playing. For any overuse injury, musicians should be on the lookout for pain that lasts into the next day.

If you are experiencing pain from playing, the first step is to stop practicing. Rest is important for recovery, especially if pain persists after playing. If rest doesn’t help relieve the pain—and especially if you are waking up in pain or experiencing pain during other activities—you should see a physician.

Researchers have found the most commonly reported skin disorders associated with playing an instrument were allergic reactions to specific components of an instrument and skin conditions caused by prolonged intense contact ith an instrument.

The most frequently reported skin conditions were allergic reactions to rosin, which is used to wax the bows of stringed instruments, and to the cane used in clarinet and saxophone reeds. Exotic woods used in musical instruments, as well as the tanning agent used in some strings, may cause contact dermatitis (irritation).

Flute, brass, and string players who are allergic to nickel and/or brass can suffer from irritation on their lips, chin, or hands, which in some cases can contribute to chronic eczema.

Researchers say many of these conditions can be prevented by changing the brand of rosin and using plastic or gold-plated mouthpieces, plastic polystyrene reeds, or bronze strings.

Another common condition is "fiddler's neck." Fiddle players who had this condition suffered from skin irritation on the side of the neck that is in contact with the violin or viola. The constant irritation causes the skin to become thicker than normal and discolored, giving it a bark-like appearance.

Guitarists also suffered from a similar irritating condition on their nipples, which researchers say can be avoided by changing the positioning of the guitar.

The pain associated with oral ulcers and acne can affect performance. There are many medical options available for treating these common conditions. If you suspect you are suffering from an instrument-related skin condition, you should seek the advice of a dermatologist and/or an allergist. Be sure to provide your physician complete Information about your instrument and its use.

Three of the most common voice disorders are vocal fold nodes or nodules, vocal fold polyps/Reinke’s edema, and vocal fold cysts. Other common voice disorders include vocal fold paralysis, reflux laryngitis, spasmodic dysphonia, laryngeal papilloma, bowing of the vocal folds, vocal fold granulomas, laryngeal cancer, laryngeal trauma, and vocal fold hemorrhage.

Vocal fold nodes or nodules can be thought of as calluses of the vocal cords and are generally due to some form of trauma. The most common cause is voice abuse. In children they are often called screamers nodes. Other factors which seem correlated are poor vocal hygiene, such as excessive voice use or singing during a significant upper respiratory infection, or chronic coughing and throat clearing which may be due to other underlying medical conditions such as gastroesophageal reflux or asthma.

Surgery is typically avoided in the treatment of vocal cord nodules since the scarring which may result from removal of the nodule may interfere more with vocal cord motion than the nodule itself. Sometimes surgery is necessary for the most advanced vocal fold nodules, but this is quite rare. Voice rest or reduction in the amount of use, as well as learning proper use of the voice, are the mainstays of treatment. Typically, speech/voice therapy is the treatment of choice. Any exacerbating underlying medical conditions must of course also be treated.

Vocal Fold Polyps/Reinke’s Edema are usually traumatic or irritative in origin. Polyps are fleshier than nodules. A single polyp may arise from a specific traumatic event. Reinke’s edema is a clinical term used to describe a common form of chronic laryngitis, wherein the entire covering of the vocal cords becomes polypoid and swollen. The condition is most often associated with irritation from tobacco smoke and/or alcohol. Gastroesophageal reflux is felt to play a causative role in many cases. These irritating substances are often coupled with some form of underlying voice abuse.

The treatment is usually surgical excision, although occasionally a small polyp may respond to voice therapy. It is essential that the underlying irritating condition be treated or stopped, or
the chronic laryngitis will return.

Vocal cord cysts: The exact cause of vocal cord cysts is unknown. They may be congenital, or may result when a damaged area of the vocal cord heals. Special surgical techniques which remove the cyst from the vocal cord while keeping trauma to the overlying surface of the vocal cord at a minimum are used to remove cysts.

Depression: According to a study of musicians done by the University of Westminster and MusicTank, 68.5% of 2,211 said they have experienced depression, and 71.1% said they had experienced severe anxiety or panic attacks. These results show that musicians are 3 times more susceptible to depression than the average person. Many professional musicians take beta blockers (ie: Inderal—generic form is Propranol) to control the symptoms of anxiousness during stressful performances and auditions. This same medication is often prescribed to control tremors in some individuals.

The pressures placed on musicians due to competition, incredibly high standards and expectations, competitive job markets, low wages, inconsistent income, COVID-19, long practice hours, and other factors put musicians at risk for depression, anxiety, and other potential mental illnesses. Mental health affects music health. See a professional at the first sign of any concerning symptoms.

Speech Language & Hearing Center (618) 650-5623

• Voice Services—Initial consultation (approx. $25 dollars for students)
• Vocal Treatments (post-diagnoses, for rehabilitating the voice)
• Transgender voice retraining
• Free Hearing Screenings for students and faculty (not a full hearing test, but it will indicate if a referral is necessary due to hearing loss)

Wellness Center (618) 650-2348

The SIUE Wellness Center offers Fitness Assessments free of charge for SIUE students. This program provides baseline measurements of flexibility, endurance, blood pressure, muscular strength, body composition, and cardiovascular fitness. Results from these tests are reviewed and can be used to create a personalized fitness plan tailored to help you achieve your health and fitness goals. A fitness assessment is also the first step to request a personal trainer.

Student Success Center

The Student Success Center at SIUE is a state-of-the-art facility that was built to maximize student success. The construction of this building supports not only academic success for SIUE students, but also the personal and professional success that will help them achieve their goals. Bringing together a diverse collection of departments provides students with a central location for many needed resources. Services offered:

• Academic advising
• Retention and Student Success
• Learning Support Services
• SOAR (Student Opportunities for Academic Results)
• Career Development Center
• Counseling Services
• Health Service
• Office for International Student & Scholar Services

Your health as a musician is important to us. It should also be important to you. Don’t wait to ask questions, or seek help—take action now. We want you to be able to fully participate in lifetime of rewarding music making!