Crafting, Music and Movement: How to Keep Your Body in Tune

Music and hobbies keep us engaged. If you're like many who use their fingers, hands and arms and sit for long periods when working on their hobbies or playing an instrument, beware that overuse can be lead to injuries. Our expert for this episode, Jean-Michel Brismée, Sc.D., PT, is a physical therapist and distinguished professor in the doctor of science program in physical therapy in the TTUHSC School of Health Professions. Dr. Brismée emphasizes the importance of taking breaks and maintaining good posture, but adds that other health issues could possibly by the cause someone is feeling pain or discomfort.

Transcript

Melissa Whitfield  0:09 
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. A 2023 study by Nature Medicine suggests that having a hobby is good for your health, mood and overall well being. That's great news, as long as you don't hurt yourself while doing your hobby. Hobbyists and even musicians who use their arms, hands and fingers might cause injuries from overuse. How can you prevent these injuries, and how can you treat overuse? Our expert for this episode is Dr. Jean-Michel Brismee he is a physical therapist and distinguished professor in the Doctor of Science program in physical therapy in the School of Health Professions. He explains how other health conditions could contribute to symptoms like arm pain or numbness or tingling in the hands. Dr Brismee also describes his approach to treatment, where he tries to spare patients from invasive procedures.

Melissa Whitfield  1:28 
Dr Brismee welcome to our podcast.

Dr. Jean-Michel Brismee  1:31 
Thank you.

Melissa Whitfield  1:32 
Can you tell us a litte bit about yourself, your expertise and what you do here at the Health Sciences Center?

Dr. Jean-Michel Brismee  1:37 
Well, I am a, you know, I'm a professor here at Texas Tech. But originally I I'm from Belgium, so I came to graduate school here at Texas Tech for my master and my doctoral studies I did here at the Health Sciences Center. And so I currently work in the Doctor of Science Program and the Doctor of Philosophy program in rehabilitation at the Health Sciences Center. So I teach mainly in the musculoskeletal area. So, you know, injury related to joints, bone, that's what I deal with.

Melissa Whitfield  2:17 
Well, again, thank you for coming on our podcast and for talking about something that is kind of, I think, universal. A lot of people have hobbies, and you're gonna help us with that. So what are some common injuries or issues you have seen among people who knit or crochet or sew or do word working or have similar hobbies?

Dr. Jean-Michel Brismee  2:38 
So about knitting, crocheting, sewing. There's two different aspects. So there's one aspect that can be used in people for rehabilitation purposes. So the studies find more and more in you know, older people middle age, older people that they will live happier and longer if they are involved in meaningful task and meaningful connection with family members or friends, so with people with back pain or diabetes or inflammatory markers, elevation. Sometimes we use these activities in context with rehabilitation. I'm talking about physical therapy, for example, or occupational therapy, we're going to use these as well as people being involved in different tasks, but knitting crocheting and sewing, it's it can become a problem when people do it too long. So the main issue with that is to take breaks, so people will tend to have issue with those relate to the hand or the shoulder, they more related to spending too much time on it. So when you love something, you have a tendency to do it longer. So sometimes I treat people that work in these areas, treat in the clinic, and they write grant, and when they write grant, they are focused on the grant, and so they sit for hours writing their grant proposal. That's a problem, and they give issue with that. Well, knitting or crocheting, it's a good thing. If you do it for 30 minutes, an hour or two a day. If you do it all day, it can create some issue with the upper extremity, was carpal tunnel or guilt tunnel, or cubital tunnel syndrome or shoulder issue. So the big deal is to take breaks when you do those

Melissa Whitfield  4:51 
Now a few years ago, I took an adult String class at TTU, and they made sure that we stretched before we got a hold of the bow and are there some, also some overuse problems with musicians, not just the double bass like I played, but other instruments as well.

Dr. Jean-Michel Brismee  5:09 
Yeah. So we did a study a few years ago. One of my student here in the Doctor of Science program worked in he was a clinician, a physical therapist, in Nashville, Tennessee, and they say, you know, I see a lot of musicians in the clinic, and I believe there are issues related to motor control. And what they do, I say, well, why don't you do a study? Let's just look at it. And so he interviewed there in Nashville, the all the musician he went to the Schools of Music, and he sent like survey to the teachers and the student in music, and they found out, well, these folks have a lot of issues of pain. And as I learned with him, upper string instrument and the lower string instrument, the upper string instrument create a lot more issues, because, like in violin, you've got asymmetrical position. Your neck is bent. You hold the instrument with one hand. You do the string with the other one. These positions are asymmetrical. They tend to do it when they do it to stand. Which is better? The one that do the lower string instrument stay more in the seated position, and long time sitting is not good. So what we found out is musician don't consider music as a sport. They consider music as an art and not as a sport, so they tend to neglect their body. Let's say, hey buddy, you need to go to bed at the same time. You need to do your your stretching, and you need to sleep every day the same that what we tell or other patient. And these guys don't listen as much so they when they practice, I say you need to take breaks about 15 20 minutes. I can't take a break when I do a performance, I'm in there for a couple of hours, and I need to be focused. And when they practice, they don't like it when you tell them to take breaks, and if they don't, then they've got more issues. So it's a good things to stretch. It's a good thing to look at the posture. So when they sit, it's better if they sit with a support in the back, and that is good if they take break about every 30 minutes. But when you tell a violinist to take a break every 30 minutes, they have a hard time to do it, and that creates some some issues. So yes, we teach them motor control for the neck, like strengthening exercise for the scapula. We found out with people that play music instrument that have got issue with the upper extremity, the arm, the shoulder, the wrist and the elbow, they tend to have more issue with the stability of the this the shoulder blade. So strengthening exercise are important, and stretching are important, and taking breaks at least every 30 minutes, and they don't like when you tell them that, so you got to work with them.

Melissa Whitfield  8:26 
So what are some signs of repetitive strain injuries?

Dr. Jean-Michel Brismee  8:30 
So most of these injuries are in the wrist, hand and the shoulder. It depend on the type of instrument, but they start to have pain. If they have shoulder pain with the string instrument is more in the upper trapezius, around the neck region, or down the arms. And so when they have shoulder issue, they don't point directly at the shoulder. The shoulder will refer pain to the arm. So they'll complain, and they say, that's your shoulder, that's your neck. They say, no, I've got pain here. Well, that's where the neck and the shoulder will refer the pain. So they've got, like, arm pain and tingling paresthesia. We call it paresthesia, tingling or numbness, and they can have that, and it can happen on the little finger or the fourth finger, and that's what we call the ulnar distribution, or the say C8 distribution. And usually they've got more issue on the owner side. So fifth, fourth and fifth finger, because it's the ulnar nerve, and so the position will give them more problem with the ulner nerve on the fourth and fifth finger, and if it involves more the carpal tunnel, the medial nerve, they've got more on the fourth finger. They've got more like tingling on this issue. And then people will say, well, I've got carpal tunnel issue. And then they go see they come see us. So they come see the physician or the surgeon. And these factors can be related to the time, so the time they spend on the instrument or doing their activities, but it can be related also to their health. They say, what do you mean? Well, most of the patient I see in the clinic, I work here at the medical office plaza at UMC, and most of my patients are, I would say 60% of my patient have chronic pain, and they pre diabetic. They've got high blood pressure, they have the A1C, is eight, nine or more, and so they are in not very good health. So if you pre diabetic or diabetic, or type two diabetic, your A1C is elevated to more likely you'll develop neuropathy. So you'll develop tingling numbness in your hands and your upper extremity. So with these musicians, because they don't consider them as sports. They tend to sit to eat not optimal food, not to take break, not to go on the walk every day, and they're more likely to develop tingling numbness related to, you know, too long time doing the same movement and not taking care of their health. So when we rehab them, it's not just you've got to have surgery. No, we need to look at, how do we move the nerve, how much break do you need to take, and what do you need to do for your general health and your general stability? So we don't just work on the area of numbness, but we going to look if you have numbness and thinking, we're going to look at your neck, we're going to look at your thoracic outlet region. And the people say, no, I've got symptoms here. Well, the study shows that you're more likely to develop symptoms in the hand, in the wrist, if you have dysfunction in the neck and the scapula. So sometimes we work on those, and we work on the health, on the walking, on the stability of the neck, the scapula, to fix those upper extremity so we we educate them on what you could do just to take care of those.

Melissa Whitfield  12:41 
So what, what treatment is available for these injuries? And when should somebody see a professional?

Dr. Jean-Michel Brismee  12:49 
So, you know, a few months ago, one of my colleague, Phil Sizer, he's a faculty up here, and his son is playing instruments, and so he was, you know, at the Conservatory, and then one of the instructor had a problem with one of her best violinist. And if you are contacting me, she emailed me, what do I need to do? Is just come to the clinic and ask the violinist to bring the instrument, if I don't see was the instrument, what he's doing, it's more difficult for me to treat. So we looked at their position and the position of the neck, the position of the arm, the position of the elbow, and I like the teacher, if they can, the instructor just to come to see what can we do to improve the positioning of the student. And so I've got the instructor and the student, and we look at what we can do, and then we work on the stability, the proximal stability, if you play instrument is good. If your core is strong, if your neck muscles, your scapular muscle, are as strong, and we work on thems having physical activity every day and taking break when they do the things and the instructor sometimes I've got to work with the instructor, because the problem is not the student it's the instructor, but they can't do that. So how can we find a way just to help them? But there's a lot that goes into education, a lot about their health and a lot a lot about the proximal stability and moving the muscle, stretching. And, yeah, I like the word stretching, but we also what we do, we floss, or we mobilize the nerve, the medial nerve, the ulner nerve. You can move them just by extending your wrist. You move your medial nerve and your ulner nerve by a few millimeter. And so it's good just to stretch, but for nerve, nerve like to be moved rather than stretch. So we taking break and moving, doing little stretching, that's what we usually work on, and educating the patient.

Melissa Whitfield  15:21 
So at what point should somebody see their physician to get a referral?

Dr. Jean-Michel Brismee  15:26 
Well, so usually, go see your physician. So I'm a physical therapist, and we have direct access. That means, like, if my you know, my friends have a problem. They can come see me, and I can educate them, and I can treat them. Financially if you work at the hospital, the hospital wants you to have a referral from the family practitioner, the physician assistant or the physician just to come see us, because better reimbursement. Okay, so do whatever you can get for that. But for me, once the patient has difficulties to do their task and they can't do anymore what they want to do, and they have pain, then go consult the physician, especially to at night. Sometimes they've got symptoms. They've got pain, numbness, tingling. They wake up at night. They can't sleep well anymore. And they can do the activities. Go see a physician, get a referral, go see an occupational or physical therapist that work with musician, and then we can, we can help them.

Melissa Whitfield  16:39 
I know you mentioned our overall health and exercise, but how can injuries or overuse be avoided? And do ice treatments? Or does heat help if we're feeling a little bit of pain?

Dr. Jean-Michel Brismee  16:51 
Yeah, so if patient have symptoms, so about the heat the ice? I go with the preference of the patient. Some people, I've got the same with sports a musician. They love ice. You love ice. Use ice. You love heat. Use heat. Now, on the long term, using ice, it helps to decrease the pain on the short term, but for the healing of the tissue, it slows down the healing. So if they do ice, I don't like them to do ice, and I explain to them doing ice repetitively slows down a little bit the healing process. It decrease a little bit the pain temporarily. It does not decrease the inflammation. It decreased the pain temporarily. But for the healing, the heat favor more movement, and heat will favor more the healing. So we do if we use ice, we use for short term, two, three days or short term, but we try to go more with movement and heat. But if my patient say, I like ice or when you're done with your activity, if you want to put it, there's nothing contraindicated, you could use it. But if you want to go to the healing stage, you've got to turn back to movement and and more with with heat, so I'm going to use those depending on that. But when I go to the healing phase, I'm going to use more heat and movement, rather than stretching, movement and motor control stability for the recovery of the patient and education about their health. And sometimes if you come in the clinic I'm treating them, I do like strengthening with weight on the scapula and the neck, because the study shows that the stronger they are proximally, the better it is. And then you've got to educate the biggest problem you have the same with people that run marathon and they come and they've got repetitive injuries, and you need you tell them, instead of running for an hour and a half, we need to slow down, and we need to run for 15 minutes. When you tell them you have to run for 15 minutes, they got a heart attack. So you say, well, you can keep running, but you're going to keep having pain. It's the same with the musician. It's like because it's going to be musculoskeletal injuries. They ever have pain, but they love it, and they want to continue. Is how much are you going to be able to influence them so they can take more breaks to give the body the time to heal. And so when I treat them is like I go more toward healing. What can you do toward healing? If they are type A personality, they don't want to hear about it. They want to hear I want to do this, and I want to go to I mean, my musician. He was going to Midland, he was going to San Angelo, and he said, I had my performance, so he was training, but we could make like progress by educating him about what to do and what not to do. So go see your physician if it bothers you, if you can't perform anymore, if you don't sleep well, if you have numbness, tingling and pain, then go see your physician.

Melissa Whitfield  20:25 
Some people might turn to videos for reminders on how to stretch or warm up if they're feeling any discomfort, I guess. How can we avoid creating more harm for people who might not have access to a primary health provider?

Dr. Jean-Michel Brismee  20:40 
I think about the these type of injuries for musician or people that do repetitive tasks with their hands. You can look on the internet. So those are not issue that will create big harms to you. It's a musculo skeletal injury. So the issue sometime is to know, like I was treating this week a surgeon, and the surgeon came for arm pain and stated, I want this to stop, because when I have to intubate somebody and my hand doesn't work, is like, what do I do? And so sometimes, when you go on the internet, you got arm pain. Is like, where is the arm pain coming from? Is it coming from your shoulder? Is it going coming from your thoracic outlet, underneath the coracoid process, underneath the clavicle, from the neck. Where is it coming from? Because for us to treat it, it's important that we find the source of the issue. So it says your brachial plexus, your peripheral nerve, your nerve root. And so for that, if you go on the internet for repetitive injuries, you may find things that are very appropriate, but if it doesn't get better after a month or two and you keep having symptoms, then ask a professional opinion, like try to get or, you know, a professional opinion to see, do you need some help at your neck, at your shoulder, at your thoracic outlet, at your medial nerve, at your ulnar nerve, at your radial nerve. What can we do? And occupational therapists, physical therapists, athlete trainer can help that, and physician, nurse practitioner can help too but we are the I'm a physical therapist, and we are the guys that will help you with conservative measure. What can you do? What can we give you to empower yourself to get better? That's what we do.

Melissa Whitfield  22:51 
Is there anything else that you would like to add?

Dr. Jean-Michel Brismee  22:54 
If you've got problems, just don't hesitate to come see a physical therapist. I mean, we we do a lot on education, and we try to help people with or, you know, physician, nurse practitioner, physician assistant, together, we work just to help people get better. And here, I hope we have, you know, an institution of complementary medicine too, at the Health Sciences Center, and so we try to promote alternative way to get people better. So on chronic pain, there's a lot that's being done with Tai Chi, Ki Gong. And if people don't like this, it's not their style doesn't fit walking, but stay moving, stay involved, and then check up with us, and we can talk to you. We can check it out in about 30 minutes. I can do a lot, and I can educate people, like I do in the clinic, and we can just help quite a bit of people just to get better without having, you know, more invasive treatment. There's a lot of things that we could treat without surgery or without things like that.

Melissa Whitfield  24:13 
Well, thank you so much for all this great information and for just really helping us out with something that we might not a medical issue that we might not think about as much, but thank you. Thank you so much.

Dr. Jean-Michel Brismee  24:24 
Thank you.

Melissa Whitfield  24:27 
Thank you for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams and me, Melissa Whitfield.