Repetitive Strain Injury
Repetitive Strain Injury (RSI) is the progressive impairment of the nerves and muscles of the hands and arms that reduces and can eventually destroy one’s ability to perform music. The numerous books and articles about this disorder that have appeared during the past few years confirm that it’s a widespread problem among amateurs and advanced performers alike.
Early indications of RSI for a student are persistent stiffness in the involved muscles and joints, fatigue, and a lack of control, accuracy and sense of security in practice. Or in the case of an advanced performer RSI is signaled by a lack of accuracy and the onset of severe fatigue which may be accompanied by a slight tremor and varying degrees of soreness, stiffness or even pain in involved tendons, muscles and joints.
When either a student or an advanced performer experiences such symptoms for a period of several days, a physician, preferably a rheumatologist should be consulted to determine whether a possible rheumatic-arthritic condition exists—an ailment which can contribute to the onset of RSI. If this examination reveals no such problem the next step should be to consult a neurologist who may diagnose an attack by one of what are often called “overuse” disorders such as tendonitis, tenosynovitis, carpal tunnel syndrome, focal dystonia, etc. These are technical terms covered collectively by the more descriptive laymen’s term, RSI. If such a diagnosis is made, the patient is usually told to refrain from playing, to rest the afflicted hand, and to assure that it will definitely receive the prescribed period of “rest,” a sleeve-like device is often applied to the forearm and hand to prevent movement.
A more recent innovative medical approach has been the controlled use of a deadly poison known as botulism toxin (botox) which is injected into the “overused” muscle. This substance causes the muscle to relax, theoretically permitting the nerves and muscles to heal and regain normal function. While I have read reports of miraculous recoveries involving “botox” experience has shown that this procedure as well as the previously mentioned sleeve-like device, are often not effective—and for a very good reason: These approaches attempt to treat the symptoms without dealing with the basic causes which have become powerful habits that resurface as soon as playing is resumed.
The term Repetitive Strain Injury indicates the gradual nature of this affliction as well as its source. The “strain” is the result of using muscles repeatedly without providing for their most effective natural leverage or mechanical advantage. Thus proper positioning and well-directed movement for optimal mechanical advantage are the primary considerations for avoiding RSI as well as for recovery. “Overuse” is, in my opinion, a misnomer; “misuse” is more accurate. It is highly unlikely that RSI will occur when healthy nerves and muscles are used according to basic principles of leverage. However, students should acquire a sensitivity to extreme physical as well as mental fatigue which can induce harmful positioning and movement thus leading to RSI.
Especially in learning to play and playing musical instruments where extraordinary levels of skill and endurance are often required of small muscles that control the fingers, neglecting to provide optimal mechanical advantage can spell disaster for the serious student and the advanced performer alike. Thus, the way to avoid RSI should be clear: Begin early in training to form habits of sensitivity to establishing and maintaining The Optimal Hand Position, pp. 2-4 of the Text, and also the article, The Importance of Leverage. A clear aim of movement is also essential. However, the potential benefits of careful positioning can be lost through a misguided concept of movement.
Treating RSI sometimes poses serious problems. Obviously new priorities must be acquired along with new habits of improved positioning and movement. Unfamiliar levels of sensitivity and awareness to an acceptable balance between dynamic strength and relaxation must be developed. New aims must be clarified and established. But it should be remembered that there are various levels and degrees of RSI and that no one can accurately predict how complete a recovery will be without trying. Unquestionably the potential for improvement is always present. The chances for a full recovery depend on how mild or how advanced the case of RSI is and upon the natural attributes of the student. Careful direction by a proficient teacher is, of course, extremely helpful.
An often overlooked issue connected with RSI is its relationship to performance anxiety (See Approaching Performance Anxiety) and the unavoidable influence of each on the development of the other. Anything that negatively affects one’s ability to perform, as RSI certainly does, unavoidably contributes to performance anxiety and vice versa.
Some musically gifted individuals appear to be somewhat impervious to the misuse of their hands; but we know that, in the playing of instruments, appearances are deceiving. Even the most intuitive of performers who have ignored the natural laws of muscle function have often paid a price in terms of aches and pain. There is even a school of thought based on the old ironical saying, “no pain, no gain!” which can boast a numerous and distinguished alumni! It is more than a little touching to realize that, despite the discomfort—often stiffness and even pain— which obviously concerned Sor and Aguado (See A Brief History of Positioning the Guitar) and other guitarists throughout the many years, they persisted in their love for and desire to play the guitar and left us much beautiful music and many valuable insights about playing the instrument.