One composer I know says every bone and joint in her body hurts all the time. She is saving up for a hydraulic lifter for her keyboard and computer workstation, so she can vary her position, working standing up as well as seated. Another I know has intense shoulder pain, and can’t raise his arm above shoulder level. He doesn’t want his clients to know, because he’s afraid they will think he can’t do the work.
The first person I ever heard of who injured his hands trying to become a better musician was the composer Robert Schumann. In trying to develop increased finger independence at the piano, he famously immobilized his fourth fingers with a length of string and ended up crippling his hands. It’s said that this motivated him to turn to composition.
Unfortunately, he wasn’t the last person that ever hurt himself creating music. It’s estimated that as many as a third of symphony and studio musicians will at some point in their career deal with pain or injuries to the hands. It’s very common to deny or conceal these problems, for fear of getting a reputation for being disabled and losing work.
In today’s world the job of composer is not a haven from such injuries. Intensive computer use, combined with the pressures of huge workloads and deadlines, can lead to serious problems if one isn’t careful. Many fail to recognize the problem until it is too late.
DO I HAVE CARPAL TUNNEL SYNDROME?
I recently discussed this situation with Laura Stewart, president of Wellspring Therapy of Glendale. In the 20 years she has been an occupational therapist and certified hand therapist, she has gained a reputation as one of the foremost authorities on treatment and recovery from injuries of the hand. She stresses that the absolute most important thing about dealing with this sort of injury is to prevent it from happening in the first place; we’ll get to that in a moment.
But what if you’re already feeling a twinge, how can you find out more about it? The news media, in simplifying things for mass consumption, have led us to believe that anything that goes wrong with the hands must be carpal tunnel syndrome. But in reality, there are a number of different things that can go wrong with your hands, wrists, arms and shoulders. Most common are carpal tunnel syndrome, tendonitis, and osteoarthritis. Here’s a simple way to tell the difference:
Carpal tunnel syndrome: Between the bones of your wrist, there are several tiny tunnels through which tendons and nerves must pass. Repetition of a motion with hands or fingers can cause swelling of the tendons that make the fingers move, constricting the nerves that share the carpal tunnel. Symptoms of this include numbness, tingling, pain that resembles a burning feeling in the hands, and eventual weakness of hands and fingers.
If this is your problem, you may feel numbness and tingling on the inside half of your hand, that is the thumb, index, middle, and the inside half of your ring finger. Why? Because the nerves that lead to those figures go through the carpal tunnel. Nerves that go to other parts of the hand go through other tunnels in the wrist.
Tendinitis: Tendinitis is inflammation of the tendons in the hand, wrist, and forearm that attach muscles to the bones. Symptoms are primarily pain and decrease in movement; this problem seldom causes numbness.
Osteoarthritis: This form of arthritis (not to be confused with rheumatoid arthritis, which is not included in this discussion) is often associated with aging, but can happen to people of any age. It is caused by the deterioration of the cartilage between the bones, the pad surfaces that cushion their intersections. Of the three types of injury, this type can most easily be diagnosed using X-rays.
STEERING CLEAR OF DANGER
Repetitive motion injuries can be serious and very painful, and can even threaten your career. There are ways to avoid these problems, or mitigate them if you’re already having some trouble, but it often can be difficult. It often takes very substantial changes in work habits, physical fitness, and even attitudes towards the work you do — real life changes.
High pressure and tight deadlines aren’t the only reason one can develop this sort of problem. Composers and other creative people are often very highly motivated, even to the point of being obsessive. It’s a rush and a thrill when a good piece of music takes shape, and one can lose track of the hours fine-tuning and tweaking the sounds with the mouse and keyboard. Later you finally come up for air and then, “Ouch!” The pain and other symptoms are often delayed.
The body wasn’t designed to do the same small repetitive tasks for an extended time, and the equipment isn’t always designed to help the body in the best way. Here are few tips on how to work smart and prevent injuries; they may look familiar, but are worth thinking about again:
Good ergonomics and posture: You must be able to reach your computer keyboard and mouse without straining. A good keyboard workstation should have a computer keyboard tray that is adjustable in its height and angle. As you sit up straight and reach for the keys, your elbows should not be bent at an angle tighter than 90 degrees. That is, make sure your chair is high enough and your keyboard is low enough that you’re not reaching up to the keyboard or mouse. Try to always hold your wrists straight and even, in a neutral position, never arched nor sunk down nor twisted sideways. Try to relax your shoulders; tension can make them rise up toward your ears. And make sure your screen is high enough that you don’t have to hunch or slump — a good rule of thumb: sit up straight in front of your screen; the top one-fourth of its area should be at about eye level and three-fourths below.
Reality check: What do we do about a workstation that also has a MIDI controller keyboard? For good playing technique the MIDI keys need to be at a proper height as well; a grand piano usually has its key tops at approximately 27- 28 in. Some people are more comfortable with a tray for the computer keyboard that is down low underneath the piano keys, perhaps on a sliding track, and some place the computer keyboard on top of the MIDI keys. It may also work to have the computer keyboard and mouse off to one side. Some trial and error may be necessary. But watch out for extremes — I know one composer who had his Macintosh keyboard down at the very far left-hand end of the 88-key controller, and the track ball to the right at the opposite end. His work position had him splayed out like he was on a cross, a real recipe for back, shoulder, and hand pain. Ow!
It’s also important to get a good adjustable chair that is the right size for you. Make sure it has good lumbar (lower back) support, and if there are armrests they should be adjusted low enough that they don’t make you hunch your shoulders or get in the way when you play music. Even though various wrist pads are popular, most physical therapist strongly advise that you don’t rest your wrists or arms while you type or work the mouse; it’s important that the large muscles of the arms and shoulders are used to support the hands and fingers, and that you have some flexibility to move your body as you work.
Keep fit. A sedentary lifestyle can lead you to getting hurt much more easily. Think of yourself as a “hand athlete” — if you did that much continual work with your legs, such as running, you would understand the need for good fitness throughout your body. Therapists often recommend cardiovascular exercise and weight training (although if you are already hurting don’t just start lifting weights without guidance!). And, as with any athletic workout, a start with a warm-up and stretches, including your hands, is always wise.
Keep your tools sharp. Just as it takes many more pounds of force to cut up a chicken with a dull knife than with a sharp one, computer tools that are stiff or worn out can make your work harder than it needs to be. The tiny movements that you do over and over with your hands should be made as easy as possible for them. Little bits add up! I recently sat down at a composer’s workstation and found the track ball to be so rough and stiff that it practically took two hands to move it. A good-quality trackball should glide with only a feather-light touch. Sometimes they need cleaning or lubrication or just replacing. Your fingers will thank you.
Take breaks and break up your tasks. When we get obsessed, or on a deadline, it’s easy to lose track of time. Taking regular breaks, even if it’s just to get up and stretch and walk around the room for five minutes, is essential. And if you’ve got more than one job on your to-do list, it’s better to do a little bit of one and then a little bit of the next rather than to power through on just one task.
TOOLS THAT CAN HELP
There are lots of “ergonomic” keyboards and other accessories out there. Different people get good results from different things. Here are a few accessories that many find useful:
Kensington Turbo Mouse: This is a large (2″) trackball. Its broad size helps you keep your hand in more of a flat position, which can help avoid pain. Also, the four or more buttons (depending upon the model) can be programmed to common actions such as click-hold (drag), double-click, etc. (Avoid the wireless model.) Many people find that a traditional mouse can cause stress and tension in their arms and shoulders, due to the fact that a lot of work you do dragging things around on the screen involves holding down the button and so your arm is continually tensed. Instead, you can momentarily click a click-hold button, then lightly roll the ball to make the edit or other drag, and then click again to release. I’m often surprised by people who don’t bother to program the buttons and get accustomed to them — give it a try; once you get the hang of it you will find that it helps a lot.
Kinesis programmable USB foot switch (Kinesis-Ergo.com): The 3 foot pedals can be programmed to duplicate any button on your mouse or keyboard. If your hands are tired of all the clicking this can help. (It can also come in handy as a “record” foot switch for punching yourself in and out.)
Voice-recognition software: The best one I have found for Macintosh is Dictate from MacSpeech/Nuance. It’s not perfect but there’s not much else to choose from. (This article was written using it.) If you use a Windows machine, Dragon Naturally-Speaking is said to be quite good. Unfortunately these are only useful for writing tasks such as word-processing and e-mail; they’re not much help in most music software.
FOR MORE INFORMATION
The book to get: This may well be the most important part of this article. If you’re having pain or other problems with your hands, or just want to learn more so that you can avoid such problems, an essential book is “Repetitive Strain Injury: A Computer User’s Guide” by Emil Pascarelli, M.D., and Deborah Quilter. This contains an absolute wealth of information about hand physiology, ergonomics, managing pain, and how to deal with medical help if you need it.
Doctors and physical therapists: Not all physicians are aware of or trained in repetitive hand injuries, and you may have to work to get your insurance to cover it. In the Los Angeles area, there are physical therapy clinics that specialize in this type of rehabilitation; some research will help you find one that might work for you.
RSI support groups: Many cities have support groups that meet regularly, in public libraries or other places, and offer informed speakers, suggested resources, and folks to commiserate with. An internet search may find resources in your community.
LES BROCKMANN is a Los Angeles-based recording engineer and score mixer with over 20 years experience in television music, from NORTHERN EXPOSURE (CBS) to KING OF THE HILL (Fox), feature films including the award-winning documentary GHOSTS OF ABU GHRAIB (HBO) and the cult howler TRAIL OF THE SCREAMING FOREHEAD (Larry Blamire, dir.), and video games UNCHARTED 1 & 2 (Sony/Naughty Dog). You can find his SCOREcast bio (and links to his other sites) here.