The painful musician’s hand from the point of view of the
surgeon
&
Caution against deciding to have surgery too early
Last Saturday I attended the general assembly meeting for the Swiss Society for Music Medicine (SMM). Before the meeting, they sponsored the two above titled lectures from Drs. Gontran Sennwald Bern (orthopedist and hand surgeon) and Brigitte Sennwald Bern (psychologist and psychiatrist). Their lectures were actually combined into one, with each presenting their points of view using 3 case studies of musicians with hand pain as examples. The most interesting part for me was hearing from Dr. Gontron Sennwald Bern about how he felt many of the pains musicians feel can actually be more related to psychological factors rather than anatomical factors.
In the first two cases, the surgeon couldn’t find any reason to operate and referred the patients to his psychologist wife who was able to help the patients clear up some psychological problems that ended up being the cause of their pain. The third had already had an operation, which failed to produce any results. As with the first two, she was able to alleviate the pain through psychotherapy. Of course they were not suggesting that all pain can be cured with therapy but I found this point of view to be very enlightening, especially because it was coming from the mouth of a surgeon. He went on to describe how every surgery will have some limiting affects on the flexibility of the hand, so surgery must be a last resort. He also stated that any surgical procedure will have affects on the nervous system that may also need to be dealt with. Apparently even the common carpal tunnel syndrome operation is not so harmless as many seem to think.
Many of us know this already, but in my practice I often encounter similar situations. People present pain and nothing (even other therapies) seems to help. For many somatic practitioners this is nothing new but I find many musicians who don’t seem to be able to make this connection. As an example, a musician might feel he’s never really good enough and that he needs to practice as much as possible even when his hand (or any other part of his body) is painful. He may be able to do this for years and years but as time goes by, he’s slowly damaging his hand. At some point, the pain begins to interfere with his playing and he seeks the advice of a physician. He might be diagnosed with carpal tunnel syndrome from playing too much and undergoes an operation to correct it. Let’s say the OP is perfect and he is pain free. What possibly still hasn’t been changed is his feeling of not being good enough and that he must practice even if it hurts. Sure, the excessive playing caused the carpal tunnel syndrome, but what caused him to practice so excessively? There’s the point at which he would need to examine his practice habits and hopefully his feelings about himself and his playing. Now this is a very rudimentary example and real cases are much more complex than this but I think it may show a how there is a connection between the psychological and the somatic.
I’ll leave you to ponder this and would be interested to hear from other practitioners and musicians on what you think about this issue.
Thanks for reading!
Be sure to check out the DMS podcasts, Feldenkrais mini
lessons for musicians and speakers.
If you have any specific questions or comments on breathing and posture, send me e-mail and I’ll try to respond in a future blog. Until then, breathe well!
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