Drumming is a very demanding and dynamic activity requiring a tremendous amount of muscle conditioning, endurance, strength and coordination. To become a great drummer we must practice long hours, performing the same repetitive activity over and over again to develop the necessary muscle memory to perform night after night. While the rate of traumatic injuries sustained by drummers are low, greater numbers of drummers and percussionists are developing significant othropaedic and musculoskeletal injuries. As a physician practicing orthopaedic sports medicine as well as being a drummer myself, I have noticed a serious and concerning trend. Each year an increasing number of drummers young and old are sustaining injuries to their wrists, arms, elbows, shoulders, knees and spine. Many of these injuries can be prevented simply through education.
Over the next year, I will be discussing a variety of topics related to medical issues in drummers. Articles covering issues specific to young drummers, in addition to those unique to older more mature musicians who may not yet be done rockin will be covered. Some future topics will include injury prevention, recognition and treatment; hearing and ear protection, nutrition, conditioning at home and on the road, nerve injuries such and carpal tunnel syndrome, proper mechanics of safe drumming and ergonomics for drummers. The first of the series of topics will be on Overuse Injuries.
Overuse Injures in Drummers
Drummers routinely participate in training programs demanding increasing levels of commitment resulting in many hours of high volume and intensity practice. We tend to practice the same activity for greater sustained periods of time. We have observed increased participation of younger musicians and with the increase of younger drummers participating in organized and competitive musical activity for longer periods of time, an increase number of injuries as well as a change in the injury patters sustained by these musicians have been observed.
Injuries can occur either from an acute event such as falling off a riser or drum thrown or more commonly as a result of repetitive trauma. Acute injuries are usually the result of macrotrauma, a single traumatic event such as a fall or a blow to the body. Common examples of acute injuries include ankle sprains, ankle and wrist fractures, dislocations and torn hamstring or quadriceps muscles.
Overuse injuries on the other hand, are the result of repetitive microtrauma to bones, muscles, ligaments, and joints. Overuse injuries develop over time and are much more subtle in their presentation. Common examples of overuse injures include tennis elbow (lateral epicondylitis), carpal tunnel syndrome, cubital tunnel syndrome, patella tendonitis of the knee, shin splints, Achilles tendonitis, rotator cuff impingement and shoulder instability syndromes, lumbar and cervical spine strain.
Overuse injuries are defined as those injuries that occur from the repetitive application of submaximal stress to normal tissue. The volume of practicing and repetition undertaken by these musicians eventually overwhelms the normal reparative process, eventually leading to tissue inflammation.
Overuse injuries can occur throughout the body affecting a variety of tissue including: tendons (producing tendonitis), bone (producing stress fractures), bone-tendon and bone-ligament junctions (producing instability) and at the growth cartilage found in the epiphyseal plates, articular cartilage of the joint surfaces, nerves passing through muscles or across joints and apophysis at the attachments of muscles to bone.
Why Do Overuse Injuries Occur?
Overuse injuries develop when the fine balance between tissue breakdown due to practice and tissue recovery is disrupted. Simply put, the tissue break down occurs more rapidly than the tissue build up or recovery leading to injury. The human body has a tremendous capacity to adapt to applied physical stress (exercise) resulting in an increase in muscle, tendon; ligament and bone function referred to as remodeling. A balanced tissue break down and build up occurs during the remodeling process.
Overuse injuries potentially will occur when we first begin a repetitive or strenuous activity performing too much too soon. This ultimately leads to inadequate recovery time.
Causative Factors
Overuse injuries result from either intrinsic or extrinsic factors. Intrinsic factors are those related to the musician themselves such as: anatomic alignment (leg length differences, hip rotation, foot deformities); growth; muscle-tendon imbalance; underlying diseases (chronic disease, previous fractures or injuries inadequately treated or rehabilitated, previously unrecognized conditions) and cultural reconditioning (too much TV or computer games-too little physical exercise).
Extrinsic factors include training errors, environmental and equipment factors.
Training errors are the most common factors predisposing to overuse injuries. These injuries develop when the drummer performs too much too soon, increasing the volume, duration and/or intensity of the activity too quickly. These training errors result in inadequate recovery time, preventing the proper tissue adaptations from taking place. Overuse injury can also develop in people returning to a sport such as drumming or activity after injury. Typically, they try to make up for lost time.
Training errors most commonly occur early on in the training program when a relatively unused tissue is subjected to stress that they may not be accustomed to. The potential for the development of overuse injuries occur when new skills are introduced into the program stressing different tissues, or when the practicing intensity is increased too rapidly. Overuse injuries also are noted to occur during the later phases of the rehearsal programs when the musician is pushing towards peak performance. It is during this time that the tissues are close to their ultimate breakdown point and vulnerable to injury.
Inadequate or poor technique in the performance of a particular activity (improper drumming mechanics) can place abnormal stress on musculoskeletal tissue leading to overuse injury.
Improperly fitting equipment or inadequate equipment for a particular activity has also been shown to predispose drummers to overuse injures. A common example is seen in drummers’ shoulders that have to reach to hit their crash cymbals or to the ankles, knees and spine when to drum thrown is to low or to high.
Environmental factors such as playing surfaces, indoor or outdoor practice or performance, and acoustics have also been shown to have an impact on the incidence of overuse injury.
How Are Overuse Injuries Diagnosed?
The diagnosis of overuse injuries can only be made after a knowledgeable physician conducts a thorough history and physical examination. Some cases will require additional diagnostic testing such as X-rays, bone scans, MRI studies, or nerve testing
How Are Overuse Injuries Treated?
The treatment of overuse injuries will depend on the specific injury diagnosed. Treatment might include oral medications and physical therapy. Decreasing the intensity, duration, or frequency of the offending activity may also be recommended. Careful attention to technique, working with a teacher, paying attention to proper warm up prior to activity, proper cool down after activity, in addition to the application of ice after practice or performances are also benicial.
Prevention of Overuse Injuries.
The majority of overuse injuries can be prevented with proper training and using common sense during practice. There is no truth in the saying “no pain, no gain”. The drummer must learn to listen to his own body and recognize the early signs of over-practicing.
Generally, if increases in volume and intensity of practice are kept below 10% per week, allowing the body adequate time for recovery and response, the majority of overuse injuries can be prevented.