Understanding Overuse Injuries: Causes and Preventions for Percussionists

Careers can come to a sudden halt for athletes, industrial workers, and musicians due to overuse injuries. Percussionists are some of the most highly injury-susceptible musicians due to the physical demand of the instruments. Understanding and recognizing early signs and identifying methods of recovery are key to prevention of overuse injuries and minimizing their impact.

Overuse injuries are also called soft-tissue injuries. They occur when the soft tissues — ligaments, tendons, cartilage, and muscles — become damaged. Soft tissues have biomechanical characteristics that help to determine their vulnerability to injury, phases of healing, varying prescribed exercises for each healing stage, and how to minimize a risk or injury. In all cases, if you recognize any risk-related injuries, it is important to consult with a licensed medical professional.

Two common types of risk factors contribute to overuse injuries, either alone or in combination: intrinsic and extrinsic. Intrinsic risk factors are biomechanical characteristics unique to each person, including malalignment, muscle imbalance, inflexibility, hypermobility, muscle weakness, instability, and excess weight. Extrinsic risk factors include training errors (excessive or repeated forces), equipment, environment, and technique. Outside factors that may contribute to an injury include changes in duration, intensity, or frequency of activity (too much or too little), or too little rest. Overuse injuries are likely to happen during transitions from preseason to competition, aggressive preparation for recitals, heavy gig seasons, change of technique, or sometimes with the simplest of physical changes such as a new pair of shoes.

The two most common overuse injuries in percussionists are in the primary muscles used in flexing the wrist: tennis elbow/golfer’s elbow and carpal tunnel syndrome. 

Tennis elbow/golfers elbow occurs from gripping or squeezing something in the hand with repetitive elbow or finger movements. This injury can occur from day-to-day activities such as typing on a keyboard, playing piano or percussion, or sports. 

Carpal tunnel syndrome is caused by the entrapment of the median nerve in the wrist as it passes through the carpal tunnel. This syndrome may cause pain, aching, and numbness in the affected hand. Other symptoms include numbness in the fingers, pain in gripping, tingling in the hand, decreased grip strength, and reduced object control precision (or combinations). This condition is caused by physical activities that require tightly gripping objects such as a golf club, bat, tennis racket, etc. Carpal tunnel syndrome is also aggravated by repetitive motions such as typing on a keyboard. Combine repetitive use and tightly grabbing mallets/sticks when playing percussion, and the likelihood of carpal tunnel syndrome increases drastically. This condition can become even more complicated due to additional external factors, causing further problems and increasing the time needed to recover.

Percussionists are prone to injuries like tennis elbow/golfers’ elbow or carpal tunnel syndrome for several reasons. First, holding a stick or mallet is unnatural. The tendency for beginners is to grip the sticks and mallets too tightly while playing. Nerves in early practice and performance contribute a lack of steady breathing and additional tension in the arms, hands, wrists, and fingers. Playing at loud dynamics and intense speed also increases the likelihood of injury. Exhaustion to the muscles, such as practicing for extended periods, make the body more susceptible to overuse injuries.

Percussionists should apply a consistent routine to aid in injury prevention. Daily warmups and cool downs can help percussionists check in with their body and address technique issues. Taking lessons with a percussion instructor allows for an additional professional point of view that may address technique concerns and improve practice strategies. Stretching exercises help ease some of the pain that percussionists might experience. Lifting weights can help strengthen muscles and areas around the tendons. Diet and rest also play a significant role in keeping the body healthy and functioning at its best. Slowly adjust (increase or decrease) the time and intensity of practice sessions. Work up to any goal slowly and consistently with time and using as little tension as possible are critical components to prevention.

STRETCHES

Wrist and Finger Extensors Stretch: Put your right arm out in front of you with your elbow straight, wrist and fingers flexed as far as possible, lengthening the right wrist (and finger) extensors to their pain-free end range. Fully flex your wrist first, curl the thumb to the palm, and then curl your fingers around the thumb as far as possible. Your primary goal is to maximize wrist flexion. 

Next, wrap your left hand around your right (providing resistance), then start trying to extend your wrist and fingers, including the thumb, slowly. Isometrically contract your extensors for six seconds. After the isometric push, maintain your wrist and fingers in the starting position. Relax and breathe. As you exhale, contract the right wrist and finger flexors, deepening the stretch on the extensors. Repeat two to three times or as needed. Switch hands and repeat.

Forearm Supinator Stretch: Bend at your waist and rest your forearms on your thighs. Bend your left elbow and rotate your left forearm, so your palm faces down. Wrap your right hand over your left so that the fingers of your right hand can hold the little-finger side of your left-hand wrist. From this starting position, begin slowly trying to rotate your forearm as if turning your palm to face up, isometrically contracting your supinator for six seconds. After the contraction, relax and breathe in. As you exhale, rotate your forearm, turning your palm down to deepen the stretch on the supinator. Repeat two to three times or as needed. Switch hands and repeat.

Forearm Pronators Stretch: Bend at your waist and rest your forearms on your thighs. Bend your left elbow and rotate your left forearm to the left, so your palm faces up. Wrap your right hand under your left so that the fingers of your right hand can hold the thumb side of your left hand and wrist. Begin slowly trying to rotate your forearm back to the left (pronation), isometrically contracting your pronators for six seconds. After the contraction, relax and breathe in. As you exhale, contract your supinators by rotating your forearm to the left to deepen the stretch on the pronators. Repeat two to three times or as needed. Switch hands and repeat.

Ryan Bond is a percussionist who is completing a Doctor of Musical Arts degree at the University of Nevada, Las Vegas (UNLV) under the mentorship of Dr. Dean Gronemeier and Dr. Timothy Jones. Prior to completing a Master of Music degree at UNLV, he completed his Bachelor of Music degree at Snow College in Ephraim, Utah with an emphasis in commercial music. Bond has performed and given clinics in Finland, Norway, and Sweden. He has performed with Opera Las Vegas, Vegas City Opera, Southern Nevada Chamber Orchestra, and the Grammy-nominated UNLV Wind Orchestra, serving as principal percussionist under the direction of Thomas G. Leslie. Notable artists he has worked alongside include John Patitucci, Eric Marienthal, and Bernie Dressel. Bond is a member of the PAS Health and Wellness committee. Bond actively clinics and teaches privately in the Vegas and Utah valleys. For more information about Ryan, visit his profile at https://orcid.org/0000-0002-1727-1769.