In this issue, you can choose any of these articles:

  • CARPAL TUNNEL STORY by Charla Gulino
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    Since I started this newsletter, Meredith and I have been exclusively collecting, writing, editing and printing every issue and the time involved has made it increasingly difficult to keep up with. As of this month, I would like to introduce 3 flutists who have generously offered to become regular contributors and editors. They are Charla Gulino, associate principal flute Santa Monica Symphony Orchestra and principal in the Santa Monica Chamber Symphony; Paula Mihalick, a freelance copy editor and research librarian in Tucson; and Karen Stafford, an elementary music specialist and a private flute instructor in the Franklin County, MO area.

    I would also like to mention John Levine, MD who has become a regular contributor over the past 2 years and the members of our advisory board who have helped keep the issues on point. 

    Thank you everyone!

    by Karen Stafford

    How many of us fall into one of the following traps: 
    Marathon practice sessions lasting 3 hours or more at one time?
    Tilting our heads to the side while playing?
    Tensing our fingers and wrists during difficult passages?
    Leaning down and in towards the stand?
    Sitting while practicing, legs crossed, elbows on knees?
    Playing with shoulders hunched and elbows up?
    Blasting away full speed in the high register, or on piccolo?

    We often don't notice many of the habits we get into while we practice, but gradually aches and pains sneak in. When I was in college, I noticed my neck would pop and crack mercilessly and would be extremely stiff. During my pregnancies, I developed carpal tunnel syndrome. Even now, every so often, my fingers get tingly and numb. These developed from bad practice habits in posture and time management, habits that I never even noticed until the problems started. They usually weren't noticed during my lessons, because I'd do my best to "behave". Through some good advice from my teachers and close observation, I've developed some techniques that can hopefully help others avoid these problems or lessen them if they have already hit.

    1. Break your practice sessions down into manageable time frames. Jan Gippo suggested to me that I break my practice sessions down by literature content: one session on warm-up and techniques, another session on etudes, and another session on solo and performance material. In college, I did those marathon practice sessions when 3-4 hour time blocks was all I had between classes, football games, and other activities. Plus, I treated the weekends as catch-up time. Not only can these large sessions cause physical stress, they can also cause lack of concentration. When you find yourself feeling sore and tense, don't "play through the pain". Stop, walk around, stretch, get a drink of water. If this pain occurs in the middle of one of your sessions, take about two minutes to recover. If at all possible, separate your individual sessions by at least an hour to give your body rest. 

    2. Practice in front of a mirror. usually touted to help improve embouchure, it's also very practical in catching those minute posture problems. Do your Moyse or Taffanel/Gaubert in front of the mirror. These exercises are repetitive enough that you can start concentrating on your stance. Then check:
    *Are your fingers close to the keys and curved, or are they flying all over the place?
    *Where's the placement of your right hand thumb?
    *Is your right wrist straight?
    *Check the angle of your left wrist to make sure it's turned enough to enable the left hand fingers to manipulate easily and centered on the keys.
    *Is your right elbow down, or is it up, pointing out, putting a strain on your back, shoulders, and wrists?
    *Relax, relax, relax! Actually, as the difficulty in technique increases, most of us do the exact opposite of what we should do. The more difficult a lick is, the more we need to RELAX : the shoulders, the fingers, everything but our abdomen. 

    3. Make sure your stand is completely eye level so you're not leaning down and in, putting a strain on your back and eyes. I know the rule in ensembles is to keep the stand so you can see and be seen, but you're in the practice room now! 

    4 Every so often in your sessions, do some relaxation techniques. 

    5. If you have had bad habits before, getting into good ones will prevent further damage, but if you have back and neck strain or tingly fingers, it's a good idea to check with a competent physician or chiropractor to take care of the "damage" already done. Performing music should be an enjoyable and rewarding experience, not a pain-filled one. No audition or recital is worth the pain that nervous, tense playing can cause. 

    In future, I would like to present some relaxation techniques that you can use in the practice room, out in the lounge area of the music building, wherever.


    by Charla Gulino

    I am a flutist who was diagnosed in 1996 with Carpal Tunnel Syndrome and tendinitis in both hands. Even though the symptoms were with me for over seven years, I held off going to the doctor thinking it would go away. Over the course of time, I consulted various doctors, orthopedic surgeons, neurologists, sports medicine specialists, and hand surgeons. I tried
    acupuncture, physical therapy, a chiropractor, herbs, and rolfing. There wasn't anything I wouldn't try to avoid surgery! 

    Nothing seemed to help. One night I ended up in the emergency room of the hospital, because the pain had gotten so severe that I passed out. Every musician I talked to cautioned me NOT to have the surgery, but the pain and lack of sleep - along with the depression and fear of what permanent damage I may be causing myself every time I practiced and performed - was ultimately
    too much. I had to start to cancel minor performances, because the pain and numbness was too great and I didn't want to mess up in a concert performance. At that point I decided surgery was my only option. I got shots of cortisone to get me by until I could schedule it during a quiet time in my performance schedule. 

    The first surgery I had done in December 1997. I have to say I was petrified, wondering if I was doing the right thing, but I had tests done once a month to monitor and assess if I was doing any damage to my hands. The doctors were pretty sure I had done some damage to my thumbs, but whether it would be permanent or not they didn't know. The surgery went well on my right hand, which was the most severe. The operation took almost 2 hours and I left the hospital that same day with a small cast on my hand. I started to practice after one week, ten minutes in the morning and ten minutes in the afternoon. The cast came off after two weeks, and I slowly increased my practicing. 

    By late January I was able to resume my professional engagements. The only problem was the cortisone had worn off and my left hand was getting a lot worse. I got another shot of cortisone to get me through until my next surgery, which was scheduled for June. 

    I am now practicing (pain free) over 3 hours a day and I hope to be working up to 6 by September. I have complete motor control of my fingers and I have not lost any coordination. 

    The thought of any musician going through this is frightening, to say the least. But I can only say I tried practically everything and read as much as I could. My case was so severe that the only thing that helped me was surgery. It may not be for everyone, but just know that if you have to make the choice to have surgery......find the most understanding doctor who knows or has experience dealing with musicians and their egos and also know it can be successful and make flute playing and practicing A LOT more fun!

    If you would like to contact me for more information, I can be reached by writing or email to HANDS ON!


    by Paula Mihalick

    With new developments constantly occurring in medical research and the wide variety of treatment options available today, it is essential for you to be proactive and participate, along with your physician, in deciding what treatments you will be comfort with in caring for your medical problem.

    In order to learn about all your possible options you will need to find information about your medical problem. One way of finding this information is through Medline--a bibliographic database of world-wide medical literature, published and maintained by the National Library of Medicine. It is one of the most widely used, comprehensive (over 9 million citations) databases produced, and because it is produced by the U.S. federal government its access has been made available free of charge to U.S. citizens.
    Medline is found on the Internet and therefore accessible through public, medical, and academic library computers, and from your home Internet connection. The current website is: PubMed is the latest development of the National Library of Medicine's Web site. Medline and other medical databases are available, along with the option of obtaining the full text journal articles (usually for a fee from the journal publisher) once you have completed your search and made your selection of relevant articles. The articles may also be found in medical libraries or in larger academic or public libraries.

    Once you access the Website, read through the introduction and online help, which gives a detailed explanation of searching methods. The database may be searched by using keywords or thesaurus terms. The "advanced" search mode is the most effective search, allowing selection of appropriate field(s) to search and more structured searching than the "basic" keyword search. Search using MeSH (Medical Subject Heading) terms for the most efficient, comprehensive search. Professional searchers search Medline using both MeSH and keywords in order to achieve an exhaustive search of the database.

    Once you have identified the thesaurus terms (MeSH) you need to use, and their combinations, then access the database and execute the search. The end result will be a number of citations with abstracts (25-40 is a reasonable number). Reading through the abstracts you can pick out those journal articles that interest you. Then you may choose to purchase the full text articles at the PubMed site, find them at the library, or select a document delivery service that suits you.

    With a little practice you will find it easy to obtain the information you need.

    Some MeSH terms that may be helpful include: hand injuries; cumulative trauma disorders; occupational diseases, musculoskeletal diseases; hearing loss; ear protective devices; finger joint; motor activity; muscle cramps; physical therapy; hand; sprain and strains; thumb; finger injuries.

    When you combine any of these terms with the MeSH term "music," you will obtain citations to journal articles relevant to musicians


    You can link to a variety of performance medicine related sites at Hands On! Links


    HANDS ON! is a public service provided by John Lunn Flutes
    The opinions expressed are not necessarily those of the editors.
    If you have questions, comments, articles, ideas or letters to the editor, we'd love to hear them.
    If you are in pain or experiencing phyical difficulties while playing, contact your healthcare provider.