Treating Musicians’ Musculoskeletal Injuries Strikes a Chord for William Muse, DO

Having an interest in both music and medicine, William Muse, DO, considered both as a career. However, his grandfather was a surgeon in WWII and his mother was a nurse. This, he says, introduced him at a young age to the satisfaction of helping people and made him want to do the same.

Dr. Muse, an orthopedic sports medicine clinician with LVPG Orthopedics and Sports Medicine–Hecktown Oaks who will be at LVPG Orthopedics and Sports Medicine–Gilbertsville when the Health Center at Gilbertsville offices open summer 2024, has come full circle as far as his talents are concerned. While he diagnoses and treats all kinds of musculoskeletal conditions and sports injuries, he has developed a special interest in the injuries experienced by musicians.

The prevalence of musculoskeletal disorders in instrumentalists ranges from 73.4% to 87.7%. At least 75% experience upper extremity symptoms, which relate to overuse. This is not surprising, considering professional musicians practice for hours at a time, repeating the same movements over and over – sometimes for decades. The reality of the profession came to the attention of Dr. Muse through his wife, Mary Kausek Muse, who plays the oboe and English horn and has performed in many orchestras throughout the US and overseas, and is currently contracted with CityMusic Cleveland chamber orchestra.

“Musicians don’t seek treatment for fear of losing work, missing out on pay for a performance and fear of not being hired if they have been injured.” - William Muse, DO

“Athletes can mix up their sports and recover over the off-season. Musicians play year-round, sometimes from age 4 to 80,” says Dr. Muse. In addition, the culture in the music world expects 100 percent dedication. “The belief is that pain is normal, and you just push through it,” he says. “Musicians don’t seek treatment for fear of losing work, missing out on pay for a performance and fear of not being hired if they have been injured.”

Besides those that result from overuse, conditions can include tendinopathy, neuropathies and nerve impingements. Musicians who play the violin or other string instruments usually have injuries of the arm or neck. They need to keep their neck tilted and hold their arm up at a 90-degree angle. Flutists twist their head and arms to the side in an unnatural position. And a drummer in a marching band carries a heavy drum on their shoulder. These positions are not only held for hours during practice but must be sustained during a performance.   

When considering what kind of treatment is best for a patient, Dr. Muse starts with a thorough examination. He asks the patient to come to the office with their instrument and watches them play. “If we can reproduce the pain, I can evaluate their posture and what muscle groups are involved when they move their body into ‘play’ position,” he says. He then suggests considerations, modifications and treatments. These might include:

• For overuse, Dr. Muse will suggest they warm up and cool down before and after playing. He’ll  advise to stop playing when the pain starts. The patient can shorten practice sessions or break them up into smaller chunks. “If they are practicing six hours a day, I’ll suggest 1 hour six times a day or 30 minutes 12 times a day. The idea is not to practice straight through. After the concert, take a break while rehabbing the muscles,” he says.
• Another possibility is to use a strap, brace or stand to offload the weight so the musician is not holding the instrument with their arms.
• Sometimes it’s possible to make modifications to the instrument itself. For example, for children, manufacturers make different size violins for different size kids.
• The most frequently recommended treatment for a pinched nerve is rest for the affected area: stop any activities that cause the compression or make symptoms worse. Depending on the location of the pinched nerve, the patient may need a splint, collar or brace to immobilize the area.
• Clinical treatment possibilities include steroid injections (for tendonitis) and physical therapy and/or occupational therapy.

Dr. Muse is also utilizing two novel treatments for tendonitis. TenJet® uses a high-powered saline stream – not high enough to affect healthy tissue – to clear away the damaged area. “While steroid injections can be effective for pain, they do not heal the tendon,” says Dr. Muse. “TenJet can stimulate healing and is a longer-term solution.” 

Another treatment is platelet-rich plasma (PRP) injections. Guided by ultrasound, the physician injects platelet-rich plasma created from a patient’s blood sample into the injured tendon or other area. This increases the concentration of specific bioproteins or hormones, called growth factors, in the area to accelerate the healing process.

Dr. Muse says that his wife Mary has had pain from her profession for years. She does physical therapy and has a stand for her English horn when playing it. She has, at times, worn a wrist brace and/or finger splints. “Splints can be used for support when the joints are hypermobile, meaning there is too much motion in the joints and they become inflamed, causing pain,” says Dr. Muse.

He says he knows firsthand that musicians focus on their work and may not think about getting treatment for injuries. In other cases, they simply don’t know there are treatments available that can help them. With all the tools at hand, he believes there can be relief for those who are active and who play music, and this is where he finds fulfillment. “I want to do anything I can to help my patients do what they love,” he says.