Pain For Pleasure: Injuries in Jazz
From our standpoint in the rapt audience, musicians are on the bandstand doing what comes naturally-swinging, burning, taking a scale and making it wail. Yet we the audience remain mostly unaware of the occupational hazards involved in playing an instrument. Unfortunately, so do many of the musicians.
The intense stress that working musicians place on their bodies often takes its toll in the form of common injuries: tendonitis or carpal tunnel syndrome from repetitive use or unnatural (i.e., incorrect) hand positioning; back, neck and leg problems from hoisting horns or lifting heavy gear; embouchure breakdowns; and a whole host of other strains, pains and physical setbacks that can seriously impinge upon a musician's art and livelihood.
"What musicians are doing is basically athletics," says Richard Zukowski, a Massachusetts-based practitioner of Hoshino deep tissue massage therapy who during a seven-year period in Boston worked on innumerable students from the Berklee College of Music, the New England Conservatory of Music and members of the Boston Symphony Orchestra. "Whether they are holding an instrument in an unnatural way or standing with one, there is an incredible amount of stress in a concentrated area when musicians play. And this can bring about injuries to the tendons, particularly the long extensor digitorus tendon in the top of the forearm, which runs from the elbow to the wrist and controls how we pick up things. In everything we do as human beings, that muscle is involved. Consequently, I tend to see a lot of those kind of injuries."
Tendons on fire, Bones on break
Keyboardist John Medeski of Medeski, Martin & Wood sought relief from Zukowski's healing touch after enduring painful tendonitis problems early in his career. As he recalls, "It happened right before I left Florida to start my first year at the New England Conservatory. I was getting seriously tight forearms and a tingling sensation in my hands, so I went to a sports doctor in Florida. I had X-rays taken, and it looked like I had arthritis, so he gave me a shot of cortisone, which helped a little bit, but it didn't take away the weird sensation that was in my hands. I remember getting in my car after that first visit to the doctor and thinking, 'Man, this is it! I'll never play again!' I was 17 and scared to death."
Medeski's problems stemmed from repetitive stress syndrome, a common malady for those who go into the woodshed far too intensely. "I had studied with a very traditional Russian classical piano teacher who was into the Lissitzky school, which is a very finger-oriented technique, and I just took it to the extreme. I would practice all the time, from the moment I got up in the morning and throughout the entire day, playing all these different Brahms exercises and doing them really rigidly, not moving my body at all. By the time I got to Boston, I was applying that same rigid classical technique to a jazz or improv setting, and it didn't work. At one point when I was playing in a bebop band there, my hands were like claws. I could barely move my fingers. I was experiencing pain and had a total lack of dexterity in the fingers."
Through a guitar player friend from Florida, Medeski later discovered the Japanese massage therapist Tomezo Hoshino, who had developed his own alternative hand therapy. Soundtrack composer Arthur B. Rubinstein was among his many clients, and Medeski says, "That was a good enough track record for me, so I went to see him at a clinic in Florida. He brought in these students and other practitioners to examine me and he told them, 'This 19-year-old man has the arms of a 60-year-old.' He recommended that I stay down there and continue the therapy, but I was going back to school in Boston, so I ended up finding Zukowski, who had opened a Hoshino-style clinic in the Berkshires. Richard started giving me this deep tissue massage and also prescribed exercises to go along with the work, and I started feeling the benefits right away. From there I got into yoga and also started studying the body-tension-reducing Alexander technique and figured out how to apply it all to what I do."
Guitarist Dave Fiuczynski of the Screaming Headless Torsos, a schoolmate of Medeski's at the New England Conservatory, suffered similar problems from repetitive stress syndrome in the fall of '85. "I had this brilliant idea that if I practiced scales 11 hours a day I'd become really good. And after three weeks of that it really started to hurt at the top of my forearms. At first I went to a sports doctor, and the guy's advice was, 'Don't play for three months and take aspirin.' Later somebody said, 'Oh, you've got the same problem as this piano player, John Medeski. He's pretty fucked-up, too. You guys should talk.' I not only met John but was also introduced to Richard. I ended up going through therapy with Zukowski, and I haven't had any recurring problems since." Today, Fiuczynski's guitar regime is far less taxing. "As far as playing goes, I know I have to take it easy and slow down with the practicing and gigging. If I had been smart as a student, I would've done some ear training, learned repertoire, done music history studies and jammed. But if people just focus on the physical aspect of playing an instrument for 12 hours a day, they end up with problems. And yet, technique is still important to a lot of people. I'm teaching at Berklee now, and I'm shocked at how many kids still want to play relentlessly fast. That's basically a career-killer. The body just isn't built for that."
Imagine trying to run a marathon without first undergoing the proper conditioning. That's basically what musicians are doing if they are not fully preparing themselves for the stresses involved in playing instruments. "The largest number of injuries I've seen have to do with people playing when they are not well-conditioned or when they play for a lot longer period of time than they've been conditioned for," says Caryl Johnson, a former Juilliard piano student who taught privately before becoming a physical therapist 30 years ago. "For example, if I'm going to get ready to run a marathon, I can't decide, 'I'll do that on Saturday.' It takes months of very gradually building up the strength, building up the endurance so that when it's time to do the marathon then it's already something that your muscles are ready to do. The problem with being a musician, particularly in the professional world, is you frequently don't necessarily do the same amount of playing every day. Say someone has to suddenly play three gigs on Friday and two on Saturday, and he's mostly been laying off or not had a job. He can hurt himself that way.
"What happens with students often is they see an exam coming up or an audition so suddenly, they practice seven or eight hours a day whereas they've usually been doing only two, so they're not in condition to handle that kind of stress. That results in an injury because the muscle is not strong enough or in good enough shape that it can tolerate it. So what happens is, the muscle does as much as it can do, and then the rest of the pull of that unit goes to the tendons, and this is how you get tendonitis."
Pianist David Berkman is another musician who pushed himself beyond his physical limits at the early stages of his career. "Toward the beginning of 1985, I moved to Boston, expressly for the purpose of studying privately and just shedding intensively as a preliminary to moving to New York. And that's when I started having problems-soreness and electric kind of feelings in my wrist, heat in my elbow and some swelling. I went to a musician's clinic at Mass General Hospital and was diagnosed with tendonitis. They put me in splints for both arms to immobilize the wrist and forearm up to the elbow, and I had to wear them 24 hours a day for three months. My first reaction was to get pretty depressed. I mean, my whole life was set up toward playing the piano, and here I was, suddenly sidelined. I felt like a retired person. I'd walk to the park every day with my splints on, get the newspaper and sit around with the other retired guys."
When the splints finally came off, Berkman worked on slowly rebuilding his muscles and playing, but found that he wasn't as fluent as when he stopped. "When I came back to playing the pain came back. My teacher, Sophia Rosoff, sent me to an Alexander teacher, and then I went to a Feldenkrais teacher. It became a couple of years of real work at trying to come back."
Few musicians have had as bad a streak of luck with their hands as pianist Dave Kikoski. In the past five years he has broken his left hand, then his right hand, suffering from acute tendonitis in the latter. "This is my third injury, and I'm hoping it's my last," he laughs. "The first serious injury happened about five years ago, when I was working with the Mingus Big Band. We were playing at a place in Manhattan where the stage was up in the air about 10 feet. It was set up pretty dangerously. There was a curtain at the back of the stage. I remember I was talking to Randy Brecker, and I just leaned back a little bit toward the curtain, and there was nothing behind it to hold me up, and I fell down. I broke my right wrist.
"I was in a cast for about six weeks. When that cast came off I did physical therapy, which got it going again, and within three weeks I was back to using it. But during that six-week period when I was in a cast I did a lot of work just with my left hand. I remember we did a week at the Blue Note with Roy Haynes and I was using only my left hand on the gig. And since I'm right-handed, that was a big challenge to comp and do solos with only the left hand while my right hand laid on my lap. In fact, one day we went to Canada and Dwayne Burno wasn't there so I had to cover bass lines too! Which is good in a way because it did strengthen my left hand. By the time I got to the Blue Note for that week with Roy, I figured I was OK."
Kikoski's second injury happened about a year and a half ago. "It was raining really bad one night and I skidded in my car and had an accident. I broke my finger on my left hand and, again, had a cast on for about six weeks. That was easier to play gigs with [right hand alone]. But the interesting thing was we did [Birds of a Feather] with Roy Haynes during that time and, ironically, it got nominated for a Grammy. If you look closely at the inner sleeve of the CD, there's one picture where you can see the cast on my left hand. I played on that recording with just my right hand, using my pinky and my thumb on my left hand because they were coming out of the cast."
The pianist's latest bout with hand problems developed from overuse. "I had been working a lot on this tricky fugue by Friedrich Gulda. It's almost like he wrote it without thinking of the pianist's technique. It's full of oblique motion and wild intervallic leaps. One day I woke up and had this tingly feeling in my fingers. It's been diagnosed as a mild form of carpal tunnel. Right now I'm checking out some different kinds of therapy and talking to different doctors, so it's yet another challenge." Kikoski continues to play one-handed gigs, usually wearing a splint on his left hand, with both the Mingus Big Band and the small ensemble Mingus Fingers.
Going under the knife
Caryl Johnson says, "I spend a lot of energy trying to use splints or other ways of protecting a person so that he may not have to have surgery. But a lot of times when it's a fracture, surgery certainly is the best and quickest way to get back to playing. That's the most common reason to have surgery, whether it's to repair cracked bones or remove ganglia on the back of wrists. Those are certainly problems that have to be addressed surgically."
Meanwhile, Zukowski rejects surgery as a way of treating even the most severe forms of tendonitis. "For most of the problems that musicians have, surgery is absolutely unnecessary," he maintains. "Granted, there is a reason for surgery; there are severe accidents, there are bone breaks, there are extreme things that people do with their bodies. But the common arthritic or biomechanical complaint, in the case of musicians, involves soft tissue, muscles, tendons and ligaments. And surgery for that is just ridiculous."
Nevertheless, pianist-singer Dena DeRose went under the knife in 1980 to resolve her ongoing problems with tendonitis and arthritis. "There was a period of about three and a half years where I really couldn't play at all," a time when she became a full-time singer. "The problem was in my right hand and the pain got so bad that it went completely up to my ear. I actually had earaches. First I saw a doctor in my hometown of Binghamton [N.Y.] and he recommended surgery. The guy didn't even take an X-ray. But you're hurting and you believe in doctors, so he operated. When the wraps came off, I started playing again, but it was just as painful. I was getting very depressed by it. I wondered if the problem was a mental thing, but I'd play a gig and be in pain the whole time and then look at my hand the next day and there'd be this little bruise as if I hit it against something. And it would happen over and over again."
DeRose was referred to Dr. Richard Eaton, a renowned specialist at the St. Luke's-Roosevelt Hospital Hand Surgery Center in New York. "He did a CAT scan and told me I had arthritis in my index finger where it connects back to the wrist bone, so he operated on it and fused the joints together. I was awake for the whole procedure. They use an actual hammer and chisel like you have in a tool shop, so he's chiseling away the rest of the cartilage in between the joints so they could fuse them together. It seemed very caveman to me, but it worked."
When DeRose's cast came off eight weeks later, Dr. Eaton told her, "Your therapy is to just play-a lot." Between the two operations and three years of not playing at all, her right arm muscles up to her elbow had weakened considerably. "When I started playing again the only thing I could do with my right hand was just plunk thirds and sevenths, really just laying my right hand down on the keys while my left hand would play bass lines. At first, of course, it did hurt, but I played and played until the pain gradually started going away. The minute my hand felt better, I packed up and went down to New York and got a steady gig playing and singing. Thankfully, the pain has not returned."
Bassist Keter Betts has also experienced surgery with positive results. "Back when I was working with Ella Fitzgerald I had some time off, so I was going to take the whole family on vacation. Just before we left I checked everything around the house and noticed that one of the well windows downstairs was broken. I was going to put a new pane of glass in, and in trying to get the frame out, I cut the tendon of my second finger on the left hand. I went to the hospital for an operation, and the doctor told me, 'Well, I don't think you'll ever play the bass again.' They put me in a cast from the tip of my fingers to the elbow, and I had to go to the hospital five days a week at seven o'clock in the morning for follow-up physical therapy in the whirlpool there. By the time Ella went back to work at the end of that six-week break, I had to be ready, too, but it was rough coming back. It took me about a week and a half to really get it together on the gig."
The following year, Betts invited the doctor to see a show and come backstage. "I said, 'Ella, this is the doctor that saved my finger.' And he said, 'I thought you'd never play again.' It's like what I tell young musicians: What might look like handicap to other people is not really a handicap at all. A lot depends on determination and your desire to play music."
Aside from the common problems of tendonitis and carpal tunnel syndrome, freaky accidents can happen that require surgery. While cleaning out the gutters at his home in Minnesota, guitarist Steve Tibbetts was attacked by a nest of wasps, fell off a ladder and fractured his wrist on the eve of a 40-city tour with singer Choying Drolma and the Tibetan nuns from Nagi Gompa. But he didn't realize the wrist was broken until a month and a half after the fall. "I had gone in and had it X-rayed immediately after the accident and the doctor said, 'You're fine.' But a sharp-eyed X-ray technician later said, 'He's not fine.' They called me back and told me I had a hairline fracture in one of the five or six wrist bones. Unfortunately, after I was initially told that the X-ray was OK, I went to play softball that night. The doctor later told me that if it the wrist bone wasn't split by the fall then it certainly was by the time I took my first swing at a big white softball."
The doctor warned that Tibbetts' wrist would become frozen without surgery, but the procedure was postponed nearly a year because, he says, "Having no medical insurance, I had to wait until after the tour to be able to afford the surgery. Strangely, I felt more flexibility and hand freedom in playing guitar on that road trip than usual. At one point I thought, 'Hey, this is great! Let's break some more of these bones.'"
Tibbetts' surgical procedure involved slicing his wrist open, pinning the skin back and drilling and screwing the wrist fragments back together with bone shavings harvested from his hip. "My injury didn't impact my chops that much because my chops are not that highly developed to begin with," he laughs. "The surgery was successful, and now my wrist is as fine as it's ever gonna be. Actually, it was not that big a deal. If I wasn't playing guitar, I might've just left it. As far as I'm concerned, if musicians really complain about their injuries, one solution is to go buy a nice Django Reinhardt record and have a look at his left hand."
Another fluke accident happened to flutist Nestor Torres, when in May 1990 he was in a serious boating accident. "My upper body was literally crushed in that accident. I suffered 18 fractures in my ribs, both clavicles were broken, and I also had a collapsed lung. We had released our first CD, Morning Ride. We had national attention, things were really rolling. I was invited to this celebrity boat race in Miami, and I had never driven a boat. Naif that I was, I agreed to do it as a favor to a friend, but I realized a little too late that steering a boat and driving a car are very different things. On the first turn of this race I got in the way of the other boat. It hit my boat from behind, went in the air and flew right on me.
A week after the accident, "I was moved from an intensive care unit to a regular room and I asked for my flute. I was barely able to put it together, and I blew a couple of notes, and that was enough for me. I put it away knowing that I'd be able to play, because somehow my lips and my fingers were still OK. From that moment on it was all about the slow process of recovery. I did not play or even look at the instrument from May until about January, when I began fumbling with the flute again."
Trumpeter Randy Sandke resorted to surgery to try and cure the painful herniated larynx he had in the late '60s. "The symptoms were visually pretty weird. When I would play the air would be diverted into this growing sac in my throat so it would just balloon out, kind of like Dizzy Gillespie's cheeks but only in one area. It got to a point where I was wrapping this gauze bandage around my neck to keep the thing from popping out [and] it was getting painful. Also, because all this air was going there instead of through the horn, I was losing control, and my technique was suffering."
The surgery didn't work, however, and Sandke quit playing trumpet altogether for 10 years, picking piano and guitar. In 1980, Sandke's trumpeter roommate convinced him that his problems were not so much physiological but rather a result of bad playing habits. Sandke began studying with Vince Penzarella, a trumpeter in the New York Philharmonic who had also worked on the techniques of Jon Faddis and Wynton Marsalis. By focusing on the fundamentals of breathing and using air efficiently, Penzarella was able to make a profound impact on Sandke's playing. "I credit Vince with turning my life around by giving me the foundation I needed to return to my career as a trumpeter."
Michael Brecker's bout with a herniated larynx led to surgery in 1973. Like Sandke, he too played with a gauze bandage wrapped around his ballooning neck. He eventually found some relief in the mid-'80s by playing the EWI, a wind-driven MIDI controller. As Sandke recalls, "Michael and I had a jazz-rock band together at Indiana University, which was one of the leading causes, I think, of us both getting this condition. We were playing with an amplified band-electric guitars and organs. We were using microphones, but the sound system was kind of primitive, and we were both really forcing to be heard.
"The throat problem doesn't seem to be a real issue for Mike anymore, although he's still very careful about not overblowing," says Sandke. "In my case, the problem was totally correctable by just learning new playing habits. And not only did the new habits solve this problem, but I think they made me a much stronger player than I was when I was in college."
Healing options abound for these various injuries, but some aren't so good, Zukowski says. "These so-called musicians clinics, which started popping up around 1987 for the treatment of musicians problems, are a joke. It's not like they're working on musicians. They're not teaching them stretching, they're putting them on machines, they're rubbing this magic wand-this ultrasound thing-over their shoulder or arms, and they're just giving them pain pills. It never gets to the source of the problem; it never teaches them how to take care of themselves in the long run."
Berkman says, "I tried a lot of things over the years but it got to a point where I had to stop because it was like, 'How can you not try herbs? How can you not try aroma therapy? You haven't tried acupuncture?' The drug guys will tell you, 'Man, you just need to get fucked-up. That'll solve your problems.' After a while you feel like you can't try anymore because there's never an end to the list of possible things you could do. So you have to find the one that resonates for you."
Zukowski's bottom line: Musician, heal thyself.
Originally published in March 2003