Musicians with Dupuytren’s contracture have an option to play
How musicians might delay Dupuytren’s contracture and help their career
Musicians with Dupuytren’s contracture know they are in trouble. After working so hard, for so long, DC can take away their music, and ruin careers. Dupuytren’s contracture does this by limiting finger spread, finger accuracy, fluidity and more. It humbles and embarrasses a musician’s playing skills.
However, musicians with Dupuytren’s Contracture have non-surgical options. Especially musicians. These options take their direction from a single realization. Musicians, more than most people, fuel their DC with bad mechanical habits and soft tissue stress. That is not to say structural and mechanical stress is the cause of Dupuytren’s contracture. Only that, in many cases, chronic low-level soft tissue inflammation in the hand and arm can usher Dupuytren’s contracture into someone’s life. Changing bad playing habits, controlling and reducing soft tissue stress and inflammation can slow the progression of DC.
Some anatomical and mechanical stresses that lead to DC are sudden and traumatic. Such as carpal tunnel surgery, or an arm fracture. Other stresses are gradual, endlessly repeated and subtle. Like a potter at the wheel, or a musician straining every part of the arms for personal perfection.
How do you want to do it?
Anatomical and mechanical stress is not the stress of the activity itself, but how the activity is done. Actually, the activity is not very important. It can be anything. What is important is how the activity is done.
Two butchers carve, chop and carry meat. One ends the day exhausted, with tight and achy hands, arms and shoulders. The other feels great, and is refreshed. Two musicians put in eight intense hours of practice. One musician is exhausted, with tight and achy hands, arms and shoulders. The other, feeling good, later goes to a small club to play in a trio until closing.
You can do it easy, or you can do it hard. How do you want to do it?
Take control of the problem
Dupuytren’s Contracture Institute started in 2002. Since then, I have questioned countless musicians from around the world about their DC and hands. I always ask how they use their bodies when they make music. Apparently, musicians commonly become tense, from the shoulders down, in two common situations:
- When fatigued and stressed
- When playing unfamiliar and complex music
Seldom is there a musician who cannot reduce this kind of situational tension. They know where this tension and stress is located in their body. And, they know when it happens. This makes changing these response and habits easier. It also makes slowing Dupuytren’s contracture easier. Keep in mind, “It is me tensing my body. Twisting and bending my fingers and arms in a weird way. I am doing it. I can stop it.”
Why this is important if you have Dupuytren’s contracture
Not all Dupuytren’s continually worsens to a crippling state. Some DC fades away completely. It just disappears for some reason. Other cases advance slowly, and then become stable for decades. There are certain internal mechanisms and responses, explored very little, that apparently slow and even stop the progression of cord and palm lump development.
Many people with DC instinctively use common sense to control and slow their DC. They stretch out, relax and use their arms and hands in different ways until they find something that relaxes the tension they feel. For some it helps a little, for others it does wonders, and somewhere between for most.
This article presents detailed ideas and suggestions to help musicians with Dupuytren’s contracture know how to do this more often and with better results.
What I learned at the U of I School of Music about Dupuytren’s contracture
For several years, I practiced chiropractic in Champaign-Urbana, where the University of Illinois is located. There, I began to treat several professors in the School of Music. Most had chronic upper body problems common to musicians. Because of the extensive soft tissue work I did, they referred their students with similar complaints. Musicians became a large part of my practice.
Previously, my patients were farmers, factory workers, the elderly and car accident victims. As a group, musicians presented a different clinical picture. In many ways, they were physically distressed in an unusual way.
Common injuries start with one sudden impact or force, often to a large area. Music-related injuries, I learned, are micro-injuries. They build over time. Small and repeated stresses applied daily for years, cause tiny isolated injuries and low-grade inflammation in the hands, arms and shoulders.
Many cases of DC start without genetic tendency, diabetes or drug side effects – and no trauma either. What I learned working with these musicians applies to these situations. There is no overt or obvious trauma. However, there is plenty of trauma in the form of daily music practice. Namely, repetitious soft tissue stress of playing of a musical instrument can be so traumatic as to trigger a Dupuytren’s contracture response.
Musicians and the Dupuytren’s contracture connection
For some people, everything they do is like a boy killing snakes.
It is common for musicians to put everything on the line, especially when striving to play a tiny bit better. Many, perhaps a majority, play their instrument like a boy killing snakes. They squint their eyes. Their nostrils flare. Their knuckles get white. They brace themselves internally in preparation for doing something difficult. They hold their fingers, hands, wrists and arms tense with effort, pushing themselves to create a better sound.
The trouble is, they are always trying to do a little better. Good musicians push themselves. However, in time, the body shows signs of all this intense effort. It takes a toll. Fibrous knots and “triggers” appear in the shoulders, around the elbows, throughout the wrists and forearms. The arms and hands become tight and uncooperative from knotted soft tissue and muscles.
Medically, all this soft tissue tension reduces blood flow, and increases white blood cells and various enzymes in the area. This sets up a complex cascade of mast cell and macrophage infiltration into the injured area. They signal a fibrous tissue infiltration into the area. This is a classic low-grade tissue inflammation response. In DC, it is a wildly excessive response. Medicine has been investigating it for 50 years plus, and they still do not understand it completely.
Bottom line: For people with a hereditary predisposition, low-grade tissue irritation and inflammation is the perfect situation to develop Dupuytren’s contracture. Avoid it.
Evaluate playing technique
Years of prolonged practice and intense effort, pushing for personal excellence, takes its toll on the upper extremities. The longer it continues, the worse it gets.
Musicians with Dupuytren’s contracture should evaluate the various tensions they create while playing. With DC as the motivation, changing structural memories and habits can reduce the tensions in the soft tissues. This will allow some level of healing to occur. In turn, this slows the progression of Dupuytren’s contracture.
If you have DC and play music, it is wise to assume you have one or more localized areas of body tension. You simply have to discover it and control it. Frequently stop your play. Locate the tenseness and rigidity of joints and muscles, from your shoulder to your fingers. Names of muscles are not important. You only need to know where, and when, you hold yourself tight for no good reason.
Genetic factors, and past medical history cannot be controlled or changed. However, how the upper body is used, and tension in the hands and arms, can be controlled and reduced. Doing so should give your body a chance to function better, and reduce chronic low-grade soft tissue inflammation that feeds Dupuytrens. This should improve your local circulation and muscle metabolism, which in turn could slow down your Dupuytren’s contracture.
Work hard to play with soft hands
Your music teachers taught you good mechanics and posture. Have your good mechanics and posture regressed over the years? How much does your posture and finger technique change right before that difficult chord or complex passage? How much do you tense up when you push your limits? As the hours of practice pass, how does your touch and tension change?
Look for your bad habits and tenseness, and change. In short, loosen up. Start practice loose, and stay that way. Practice being light and easy during difficult passages and sections. Focus more on you, and less on the music – at least for a while.
Recognize you are probably:
- Pressing on strings, frets and keys harder than necessary to get the same sound
- Holding your bow or pick with more tension and force than necessary
- Tensing hand and forearm muscles in ways that might help your technique, but hurt the muscles, joints and ligaments
- Practicing beyond fatigue, causing your posture to falter, tensing from the shoulders down
- Abandoning good mechanics for the sake of better sound
Because of bodily excesses your musicality is not as good as it could be. When you play hurt, you cannot possibly play at your best. Ironically, what you are trying to improve and accomplish in your music with these excesses only diminishes it.
Strategies to reduce upper body stress and tension
Experiment with different ways to reduce muscle tightness and tensions that will benefit your fingering technique. (Remember, what you do way up in your shoulder influences your fingers.) Large changes are not necessary. Tiny shifts in angles, degrees and muscle contraction can greatly improve how the body operates and performs:
- Change the angle of a bent wrist, or straighten it completely
- Straighten a finger that is usually bent
- Bend a finger that is usually straight
- Intentionally roll the shoulder a little forward, first the left, then the right
- Deliberately push the shoulder back just a tad, first the left, then the right
- Sit further back, or further forward, in the chair
- Sit with a small towel under just one butt cheek, then the other; change the towel thickness
- Stand with one foot forward, and then the other.
- Stand with the toes slightly turned in, then slightly turned out, more than usual
Musicians with Dupuytren’s must experiment
Make just one change at a time. Try it for a whole practice session, or longer. Do not rush the process of experimenting with new ways of doing old things and postures. Give each a fair chance to loosen achy and tense hands and arms. Do not be too quick to say something is not helping. It takes time.
Experiment with all aspects of your finger and hand music technique, and playing posture. See what happens. Little goofy tweaks in posture and arm position – how you do what you do – can have a positive ripple effect up and down the chain.
See how good it feels to stop beating yourself up.
Your chronically abused upper extremities – and Dupuytren’s contracture – need more help than you can provide.
Seek out a great professional massage therapist; they were once known as body workers. A person who identifies and eliminates chronically tight and contracted soft tissue associated with a variety of pathologic states. Someone who has gifted hands. This is not someone who does nicey-nicey full-body massage. A serious massage therapist can sometimes make you feel uncomfortable. It is worth it to make dramatic deep soft tissues changes that are permanent.
Or, look for a chiropractor who does a lot of manual soft tissue work. Someone with extensive training and experience in kinesiology, orthopedics or sports medicine. Lots of experience.
Note: Be careful who you ask for a referral name. Ask people who have a reason to know who is best in your area:
- Yoga teachers (not just a yoga student)
- Martial art instructors (not just a martial art student)
- Owners and managers of fitness and exercise centers
- Gymnast coaches
- Seasoned body builders
- Seasoned ballerinas, professional dancers and those who teach them
These people are connected to a select community you do not know about. They know who has the special skills and gifted hands you need.
Once you find someone to help you, they can do more than work your tissue. Ask to bring your instrument into the office to watch your play. Get advice and suggestions about changing various postures while you play. Small, but important, things to do while you play:
- Raising or lowering your elbow or shoulder
- Bringing your instrument closer or further away
- Holding your instrument at a different angle or direction
- Finger placement on your instrument
I did this all the time with my U of I musicians. The benefits were often dramatic.
Stretching Dupuytren’s contracture gently is important
Also, it is critically important to stretch this tense soft tissue gently. How to do it safely and effectively is a large subject. DCI discusses simple gentle stretching methods here. How to safely stretch Dupuytren’s contracture
Forced to stop doing what you love
Dupuytren’s contracture is a lousy problem. It can take you in a horrific direction no one wants to go. Over the years, I have talked to many musicians who could no longer play. Professional musicians who had to quit music. How sad.
If all this is a difficult imposition to your art, so is being forced to quit. You have sensible and conservative options to play. Do not stop what you love to do without first vigorously exploring all possibilities.
These ideas and suggestions are often helpful at least to a small degree, and sometimes to a great degree. Success depends on how well you use these ideas. When these ideas do not help, it is typically because Dupuytren’s contracture surgery complicated the situation too badly.
You will never know unless you try.
If you are a musician with Dupuytren’s Contracture please send an email to firstname.lastname@example.org to discuss reducing your upper extremity stress.