It’s been said that if OSHA scrutinized violin playing and the inevitable injuries it causes, the safety agency would have to ban it. The occupational hazards of a string instrument — repetitive strokes of a bow, constant flattening of fingers, unnatural contorting of the body — can even lead to a neurological disorder that can end a performer’s career. But you can’t tell a professional musician with stress injuries to hang up his instrument and become an accountant. “When a musician can’t play, they are losing not only possibly their livelihood, but also the talent that brings joy in life,” said Michael Charness, 66, a neurologist who specializes in diagnosing and treating concert hall maladies. A once music conservatory student himself who has performed in dozens of recitals, Charness was sidelined by an injury after practicing many hours daily without taking enough breaks. He understands the fear of losing the ability to play and being told that “if it only bothers you when you play, then stop playing.” Charness was one of the first music medicine physicians. Three decades ago, he established the Performing Arts Clinic at Brigham and Women’s Hospital. He estimates he’s since treated about 3,000 musicians at the clinic. Common injuries include numbness, pain, and strain in the hands, wrists, shoulders or neck – often caused by relentless practicing. The Globe spoke with Charness about how he went from scales to scalpels.
“There is greater awareness of the unique problems of performing artists today than when I entered the field. It was 1984, and I was doing laboratory research and performing in a piano trio during my off hours. I developed entrapment (pinching) of the ulnar nerve in my elbows, but the only symptom was a progressive loss of facility in playing piano. None of my neurology colleagues could figure out what was going on, but eventually the violinist — and neurosurgeon — in my trio diagnosed my condition. I eventually healed, and other musicians began to ask me about their hand problems. Though I had no special expertise outside of neurology training, I began learning as I went along. Within a few years, I was seeing musicians throughout the US, in part because there were very few places that specialized in their problems. Now I see a large number of pianists, string players, and guitarists but also bagpipers, tuba players, drummers, marimba, accordion, and even penny whistle.
“I once saw a musician who plays the charango, a South American plucked instrument made from an armadillo shell. Another time, a musician wheeled a virginal into my office, a 17th century keyboard instrument akin to a harpsichord. All are welcome.
“The most common injuries are tendinitis and nerve entrapment syndromes, such as carpal tunnel syndrome or pinched nerves in the neck. I also see musicians with focal dystonia, a condition where the hand twists into odd positions when playing but functions normally otherwise.
“Over the years, I’ve discovered that the highest-level musicians are distinguished by not their strength but their skill — how to move the least muscles for the best results. It’s like watching an experienced skier versus a novice; the beginner is flailing around while the expert is smooth and controlled.
“Most people understand the concept of sports injuries — musicians are small-muscle athletes. A lot of unnecessary muscle activity — lifting shoulders, pressing keys too firmly, bending the wrist too much — can cause playing-related injuries. But I’ve also seen musicians with non-musical related injuries, like cutting a bagel with a sharp knife, scooping ice cream as a summer job, and even tuning pianos. Actually, I’ve seen quite a few piano tuners. It’s very repetitive work that involves a lot of wrist and finger movement. I even once saw a musician who fell into an open manhole. Obviously his maladies had nothing to do with practicing too much.”