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Home Forums Medical Management High School band conductor, cervical strain with numness

This topic contains 19 replies, has 8 voices, and was last updated by  admin 16 years, 4 months ago.

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  • #36625

    msotr1
    Participant

    A few of the high school band condutors are experiencing significant hand sensory impairment and motor weakness. Are there specific exercises or adaptations?

    #38517

    edgar528
    Participant

    Any more specifics on location of numbness, when it occurs, intermitt vs. constant, ipsilateral/bilateral, relationship to dsyfunction of c-spine/shoulder? Ed, P.T.

    #38507

    JeffdlS
    Participant

    What type of baton are they using? Is it a rosewood handle? If so, they might want to try one with a softer handle.

    Of course, it could be because of throwing their baton or erasers or whatever else they can get their hands on at the percussion section ;-)

    #38516

    msotr1
    Participant

    for one of the conductors, the numbness began in the hands and traveled proximally, he spends up to 6 hours a day at a stand postition conducting, he has one physician recommending surgery and another recommending therapy

    again, symptoms are bilateral and he reports relief only at rest in bed

    #38523

    msotr1
    Participant

    You gave me a good laugh, however a do believe the tubas have been ducking a few flying items!! He is using a rosewood, very small.

    The other conductor also comducts a childrens orchestra also uses roeswood and I can tell you his sitting postion when conducting at rehearsal is painful to watch.

    #38525

    JeffPT
    Participant

    I wish them both luck as they are doing angel work bringing serious music to school age children. Regarding their numbness and weakness, last resort is surgery, but time is of the essence. Recommend that they see a manual therapy based physical therapist for a full evaluation. I see many patients who, with relatively little intervention, return to full activity once postural, muscle imbalance, and cervical spine alignment problems are resolved. Then, let the tuba player beware.

    Sincerely,

    Former 2nd seat trumpet player

    Berner High School

    Massapequa, NY

    #38526

    edgar528
    Participant

    Therapy should help significantly. Have the PT rule out postural options as previouslu mentioned including thoracic outlet. Onset of bilateral symptoms are generally related to postural causes versus isolated cervical problems. Of course R/O cervical patholgy would be appropriate first step. Ed

    #38527

    Pronator
    Participant

    Thanks for your post. This especially caught my eye, as I see a lot of Thoracic Outlet Syndrome patients. Band conductors spend a lot of their time with arms overhead, gingerly moving the arms in this position, for extended periods of time. Considering the anatomy of the brachial plexus extending from the cervical spine and weaving between the anterior & middle scalene muscles and between the first rib and clavicle, performing with arms overhead can cause nerve compression at the shoulder (cervicothoracic) level, leading to symptoms in the arms & hands. Examination for musculoskeletal imbalance & treatment (physical therapy) to restore neuro & musculoskeletal mobility as well as muscular re-ed (i.e. rotator cuff, scapular stabilizers) can lead to resolution of the symptoms you describe.

    Teri (Pronator)

    #38529

    admin
    Keymaster

    As I read the responses you are getting I must agree that suregery is the last resource and PT will help. But you really need to watch how they are playing the instruments and think of what kind of modifications they can do to the posture or the instrument. The bottom line is that these kids want to continue playing the instruments and all the therapy in the world is not going to eliminate what is causing the problem. The is a physician in San Franscisco who is also a musician and he helps the musicians modify the instruments then decides if they still need surgery. Let me know if you need the name.

    Alicia Perez, PT, CEES

    #38530

    JeffdlS
    Participant

    Another thing you might want to look at is where his music stand is in relation to where he is standing/sitting. More than likely, the music stand is low . . and it’s possibly too low. They probably keep it at such height in order to keep their eyes on those tuba players & drummers (everyone knows a trumpet player would never cause trouble ;-)

    They might want try some stretches as mentioned in NISMAT’s page on Thoracic Outlet Syndrome: http://www.nismat.org/ptcor/thoracic_outlet

    Do these directors only do orchestra conducting or do they do marching as well?

    #38531

    msotr1
    Participant

    Althugh i have been addressing the conductors, you are right about the students. The 16 year old jazz pianist and primary violinists are experiencing problems (soreness. fatigue and numbness) Any resourses would be helpful.

    #38532

    msotr1
    Participant

    Both gentleman do both. One conducts 2 concert band, the marching band and a childrens orchestra. The other conducts 2 jazz bands, a concert band, a marching band and an advanced high school student orchestra. I’m SURE the trumpets have been very well behaved!!!

    #38533

    lampehan
    Participant

    Have you considered the height of the podium. It is important for the back row players to have eye contact, so the conductor may be raising the arms higher than is necessary.

    My community band director had problems for a while until he built a new podium that was 4 inches taller.

    Flutist who is still playing…

    #37772

    Pronator
    Participant

    I have found that people who perform extensive overhead activities tend to over-develop delts & traps (upper) and neck (scalene, SCM) and lose strength/endurance in middle & lower traps, serratus anterior & the rotator cuff. Exercises that would be appropriate would include scapular retractions (rows), scapular protraction (reaches against resistance, i.e. Theraband), internal & external rotation in rapid reversals and/or resisted with Theraband or free weights. Increasing scapular stabilization, ability to upwardly rotate the scapula as well as posteriorly tilt during shoulder flexion and abduction and facilitate humeral head centering in the glenoid will provide the least amount of compression on neurovascular tissues. It’s common that the 1st rib may be elevated, capsule & GH ligaments become hypomobile, so if these exercises don’t help, manual therapy should be considered. Good luck! May the band play on!!!

    Teri (Pronator)

    #38536

    msot_mpadilla
    Participant

    I feel for the conductors, but posture and arm hieght appears to be a key factor in increasing or decreasing pain. As an Occupational Therapist, I agree with how the brachial plexus(the route the cervical nerves take and then form) can be involved and affected over time, without rest. I see the issue as preventative. That is to say, I think the conductors should consider asking their doctors for a script for an OT or PT evaluation, so as to strengthen the upper arm and neck muscles. as a preventive measure. Secondly, in Occupational Therapy, we examine your pace and effort put forth, and adjust it to your task or occupation to enhance delivery of movement. For example, perhaps the conductor(s) can breathe correctly (deep diaphramatic breaths), alternate hands as much as possible with the use of the baton, and rest either one or both hands whenever a break allows. Again, the podium height is key, as it cannot be too high, but instead a a resting 80-90 degree angle, perhaps. In this manner, the cervical nerves can recuperate in the task, and are not put on strain for long periods without rest! This problem holds true for busy hairdressers as well, as their arms are held high and upwards without a break, especially if overbooked.

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