Advances help musicians with repetitive stress injuries continue to play

It should have been a career-ending diagnosis.

Twelve years ago, Randy Harrison was a professional tuba player for orchestras along the East Coast, including the Baltimore Symphony Orchestra, when he was diagnosed with Facioscapulohumeral muscular dystrophy, a weakening of the muscles that affects the face and upper body. Eventually, his muscles would give out until he couldn't play anymore.


An inherited genetic disorder, Harrison's case likely would have gone unnoticed. But a lifetime spent practicing and playing for hours each week had overused the muscles he needed for his instrument.

At the time of his diagnosis, Harrison didn't have any treatment options.


But he wasn't ready to give up on his lifelong passion entirely. Instead, over the course of two years, he consulted other instrumentalists and teachers, eventually discovering he could still play French horn, which used different muscles that hadn't yet been affected.

Now 66, Harrison plays the French horn for local and regional orchestras, while also teaching on the faculty at the Maryland Conservatory of Music in Havre de Grace.

While Harrison had to search for his own solution to keep playing, technological advancements, a growing body of research and an increase in specialization from the medical community is making long-term rehabilitation possible for musicians who before would have had to stop playing entirely.

Many of the advances focus on repetitive stress injuries –- tendinitis, nerve entrapment, muscle strain or carpal tunnel -- because most instrumentalists will face problems from these overuse injuries. But these new treatment options also extend to other cases that might have before forced musicians into an early retirement.

Dr. Serap Bastepe-Gray, founding co-director of the Johns Hopkins Center for Music and Medicine that launched in 2015, has simplified a slew of recent research into a simple statistic. For every five professional musicians, four will have some type of injury during their career. Two will continue to play but never fully recover. One will quit and do something else. Only one of those will recover quickly and completely enough to return to playing.

"Clearly if 80 percent of musicians are dealing with injury and it has disastrous effects on the musician, the idea that they're going to get injured, go to the clinics, get fixed and back to play is not working," Bastepe-Gray said.

More than 30 years ago, Towson-based physical therapist David Shulman, a former clarinet and sax player himself, started specializing in treating musicians with repetitive strain and overuse injuries.

For many years, he was one of the lone specialists in the Baltimore region. What's changed, he said, is "the idea that musicians are not just people who sit in a seat. And that you will get overuse and you will get hurt. That has now become knowledge. Because of that, people are starting to get it and work with it and they're starting to make changes."


At the University of Maryland Rehabilitation and Orthopedic Institute, occupational therapist Heather Weesner has watched newer therapies, from biofeedback therapies, where the musicians can visually see whether they are playing correctly, to take-home treatments they can use at home, help musicians recover and get back to playing.

"I've seen a lot more people recently being able to return to their instrument at their [previous] levels" in the last 14 years, she said.

Bastepe-Gray quit medicine to train as a classical guitarist at Peabody Conservatory when she faced an overuse injury in the mid-1990s. At the time she couldn't find any treatment. Instead, she designed her own rehabilitation program, recovered and finished her music degree. That experience led her to relaunch a medical career focused on instrumentalists, which ultimately led to the new center.

Bastepe-Gray, working with faculty from the Johns Hopkins Department of Biomedical Engineering and from the Johns Hopkins Medicine's Department of Neurology, is developing a smart guitar that will measure how much a guitarist is pressing as they play.

She's also developed a program with Hopkins' Neurology Department's Dr. Alex Panteylat, the other co-director of the center, to treat focal dystonia, a neurological condition that causes the player's hand to stop responding – often it will curl up unintentionally into a fist – when a person tries to play.

And now the Johns Hopkins Center for Music and Medicine is partnering with the Peabody Conservatory to start treating the conditions before they start.


Earlier this month, the Peabody Conservatory launched a program to monitor and study all incoming instrumentalists, beginning with violin and viola. Students will be screened for their playing postures and techniques, hearing and mental health. The conservatory launched a similar effort with vocalists last year.

The program includes a mandatory five-day Wellness Immersion Week for all incoming major ensemble program students and is open to all students.

"What we're trying to do is create more visibility for an honest and open conversation about playing-related injuries and conditions so that we de-stigmatize, de-mythologize and de-catastrophize these different situations that our students encounter," said Dr. Sarah Hoover, associate dean for innovation, interdisciplinary partnerships and community initiatives at Peabody Conservatory.

Next month, the partnership will launch Peabody Clinic, which will provide treatment and prevention services for students at the conservatory, eventually expanding to treat musicians in general.

Violinists and violists are the most affected, following by guitar, piano, cello and bass, percussion, harp and wind players, according to Hoover.

Helping to raise awareness of injuries and forward the treatments are other former instrumentalists who, like Bastepe-Gray, faced potentially career-ending diagnosis.


Baltimore Symphony Orchestra's President and CEO Peter Kjome was a professional oboist before a medical issue affected his playing and, eventually, forced his retirement in 1998.

"The topic is much on my mind, and I know how it feels to be a musician and have medical issues affect one's playing," he said.

The orchestra has expanded its health insurance benefits to cover acupuncture, and a wellness fund in the plan is used to offer massages to the orchestra's musicians. He also points to a sick leave policy that allows ample time off for recovery and a long-term disability plan that can cover longer recovery periods.

While the orchestra hasn't partnered with any of the developing programs or initiatives in the Baltimore area, it's an idea Kjome is open to.

"As an institution, we are going to continue to ensure we are paying the right attention to and listening to our musicians and understanding what leaders and others at Johns Hopkins and others are doing to further a possible solution," he said.

Advancements in treating repetitive use injuries are also leading to more options for those who face other problems.


A tumor from B-cell lymphoma entrapped the nerves of Kinta Thomas' right arm, crucial in his work as a producer, engineer and piano player. This past spring, swelling started in his right arm a month after his last major surgery until, eventually, he couldn't use his right hand or fingers.

He could still program music on the software he uses with his left hand, his dominant hand, but it wasn't the same. "It can be frustrating when you can't do the things you want to do," Thomas said. "I was getting to a point, because I hadn't been playing with my hands for so long, that I felt like I was losing."

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The 36-year-old Laurel resident started occupational therapy in June at Johns Hopkins outpatient physical therapy services in White Marsh. Twice a week, he works through a number of tools and new therapies, including a surface electromyography instrument where nodes placed on weak muscles send a small current of electricity to stimulate and strengthen them.

He builds strength in his finger and wrist muscles, moving through a series of exercises on a large machine designed specifically for the hand, racing against a computer model.

Nine weeks into this therapy, Thomas was back to playing simple chords and songs. Though he still has lingering weakness in his thumb and small finger, "my goal right now is getting my hand to 100 percent," Thomas said.

While both Thomas and Harrison talked to other musicians and teachers as their playing issues worsened, they are rare. Most facing injuries keep it to themselves and practice more – which only makes the issues worse. This is another barrier to recovery that doctors see changing.


"Now people are beginning to talk so people are coming in earlier," Shulman said. "It's just going to take some more time."

"Musicians have been an after-thought or a not-thought," he said. "But thankfully now it's changing. The trend is moving in a different direction and all I can do is pray … that it doesn't lose momentum."

An earlier version misstated the affiliation of the University of Maryland Rehabilitation & Orthopaedic Institute. It also mischaracterized which musicians can be affected by focal dystonia. While guitar players are disproportionally affected by the neurological condition, it is not unique to them. The Sun regrets the errors.