Why do injuries happen?

Abby Halpin, physical therapist and coach for musicians and artists, talks about why injuries happen and what to do when they do. She also shares why she greets the day like she greet you!

Main points:
1. Pain does not equal tissue damage
2. Injuries happen when the load on your body outweighs the resilience you've built up.
3. Don't give yourself training whiplash.
4. Rest is not always (often isn't) the answer.
5. You deserve care from a PT who knows what you need as a musician.
6. Don't take "stop playing" as an answer.
7. Let me know what you need.

• Transcript

  Good morning, World! Today is going to be a great day!

  Welcome back to Play life loudly. I am your host, Abby Halpin, the physical therapist who wishes she was a music teacher. Today I want to talk to you about why injuries happen and what to do when they do.

  But before I do, I wanted to start by telling you why I am greeting you like this. When I was a kid, my dad would wake us up in the morning. He would do so by running into the room and opening the blinds and TOP OF THE MORNING, WORLD! It’s going to be a GREAT day. Then he would jump around a bit more and turn on all the lights and run out of the room, presumably to go torture my brother in the same way. This habit of greeting the day stuck with me, and once I got over being an annoyed teenager that couldn’t deal with this enthusiasm, I turned into my dad. So that is how I greet the day now. It’s worked out pretty well, so that is how I will greet you. I realize it may not be morning when you listen… but the sentiment is the same no matter what time of day it is.

  So today, I want to talk with you about why injuries happen.

  The first thing to say is that discomfort and pain do not mean that damage has happened. We know this because we can delay pain experiences when safety is on the line, even when damage has occurred. Say you sprain your ankle by tripping on a microphone cord on stage. Under normal circumstances, you grab your leg, fall over, and cry. But say there are 300,000 people watching and waiting for your performance. You are likely going to either massively downplay your response, or maybe you even make it through the performance before hobbling offstage and then laying on the ground and crying about your ankle, are you? So your brain overpowers the pain due to incoming danger signals of OMG, people are watching, my career is on the line, this performance is so important to me. I say all of this just to put it out there that you do not need to assume there has been a structural injury if you have pain. There are a thousand reasons you may have pain. That is a story for another day.

  I just had to say all of that before I get to the next part of this.

  Injuries happen when the load you place on your body is suddenly much more or much less than the resilience you have built up. You make something work harder than it has been, and you are alerted to possible danger because of this. The danger can be interpreted as pain to get you to stop doing it. It’s trying to help you! This can be due to literal load (how much weight you’re lifting), a change in intensity (how fast you have to move, how powerfully you have to move), a brand new position that you haven’t gotten used to (now you have to stand or sit or sit in a rotated position). Most commonly for musicians, it’s the volume. I see this when patients have been practicing steadily for 30 minutes 2-3x/week, and then they have a big competition or event, and they practice for 8 hours 2 days in a row and then have to perform three shows in a weekend. If this happens at the same time as the music being more intense and you don’t sleep, and your eating routine is off and and and and, your alerts to danger are going to be louder than they would be if there were a gradual shift in increasing your playing, OR any of those other factors weren’t true.

  It is important for me to share this because the cycle I see a lot of musicians getting into is they have a big bump in practice/performing, so something starts to hurt a bit. So after their last show, they rest for a week. Then they start practicing again. So you go from moderate practice to intense, long-duration practice, to the high-intensity and routine-smashing performance to zero load. Stopping completely and then starting again actually makes you more likely to hurt again.

  There are always times when you need extended rest. But ideally, you take that before you need it. And if something is uncomfortable, make sure you have guidance to maintain some level of practice or skills work so that your tissues don’t have another shock to the system getting back into it again after sudden rest. Basically, don’t get your body training whiplash. Physical therapists are excellent at finding a way to keep going, even if it’s heavily modified. Don’t avoid getting care because you are afraid someone is going to tell you to stop playing. If you do get that message, get a second opinion.

  I’m curious to hear what your thoughts are about this. Have you had this experience? I know I have!

  Remember that you deserve care from someone who knows the requirements of being a musician. Because we are all better when you get to do you!

  As always, let me know what you need!