So what counts in tendon problems and what is the go with rehab? Well four things are important and three you will know:
1) Strength 2) Load 3) Kinetic activity (how the whole limb moves) and 4) The Brain. And research shows that Brain is as big a factor as Braun, sorry Arnie!

In composing a rehabilitation plan a physiotherapist will look at the first three tendon related factors but also, we must examine the cortical drive. Cortical drive could be called muscle memory, motor control or brain training.

Physio researchers at LaTrobe University has shed light on this in recent times. In tendon pain the brain is like a learner driver, it makes the muscle contract completely or not at all and it peters out very quickly. The result is that the tendons are loaded in an awkward way that affects its metabolic health. Think of learning to drive and all the bunny hops (or donuts) you did. Imagine what it did to the engine!!

Dr Ebonie Rio with her team demonstrated ⁽¹⁾ that static hold (isometric) exercise can be not just train muscle but be pain relieving. This is because it activates the brain to relieve pain (the brain has a drug cabinet called endorphins) and it reshapes that activation pattern of muscle not to be stop-start but flowing, undulating, oscillation. I often say to people their muscles are like an orchestra and this another example. Even better, loading and ramping up to the non-painful limb has neural carry over to your recovering tendon side.

Whether someone is an elite musician or a student embarking on a new instrument, muscle, joint and tendon injuries are highly prevalent within their career. With thousands of hours spent in repertoire practice, technique exercises and perfecting what is required to produce "beautiful music", it is no wonder that musicians do injure themselves, and often. Performance stress and anxiety can also be a major factor.

Anecdotally, here in Australia, we find it surprising that so little time is spent in music education teaching students about the need to stay healthy and to recognise where performance can hurt musicians. Music performance and musculoskeletal health are not mutually exclusive. The key is learning preventative strategies and installing good healthy habits in our performing artists.

The shoulder blade (or scapula) is key in upper limb and neck biomechanics. This includes the elbow, as in the video. This scapula is a moving platform for the ball and socket shoulder joint. It sits on the back of the upper torso enabling us to shrug and reach. Poor scapula position awareness (a wobbly or uncoordinated shoulder girdle- if you like!) can affect the neck, the shoulder and arm muscles, joints and nerves ⁽¹⁾.

A new study of musicians by Silva⁽²⁾ examined the coordination of shoulder blade position and neck control. Musicians carrying an injury performed poorly in muscle memory tests with uncoordinated neck control. This makes sense, as with any injury, our body directs a change in muscle memory patterns to essentially maintain the same movement.⁽³⁾ For music production, however there is no margin for error. The prevention and fix for these problems lies with the development of habits which include:

Neck pain from the musculoskeletal system (that’s our joints and muscles) is common affecting 70% of us in our lifetime and 50% of us in any one year. It is likely to reoccur. In summary neck pain is one of the leading causes of disability.⁽¹⁾ When this is examined more closely, we find pain changes the way the neck will coordinate head-support and movement in different ways.

First there is reduced endurance of the supportive neck muscles. They don’t activate and contract smoothly, they fatigue quickly leaving the neck joints (both facet and intervertebral disc joints) assuming more of the work load. As well as control loss, there is strength loss. Second, the joints stiffen become less flexible and are easily irritated. Thirdly head movement accuracy is affected, meaning when tested, a neck pain sufferer cannot look away and return to the same position.

​Exercise is recognised in research trials and clinical guidelines as beneficial,⁽²⁾ but it is not a one size fits all approach. That’s because there are many kinds of musculoskeletal neck pain. For example neck pain from whiplash is different to that of a headache or migraine sufferer, and again different from the pain of age related changes. Combination pains do occur and on occasion the involvement of the nerve system can make neck pain more complex.

This highlights that neck pains can have different mechanisms of ignition and different mechanisms of being sustained.

Complexity doesn’t mean complicated

References:
1.       Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. (2017). The Lancet, 390(10100). doi: 10.1016/s0140-6736(02)65865-9
2.    Fredin, K., & Lorås, H. (2017). Manual therapy, exercise therapy or combined treatment in the management of adult neck pain – A systematic review and meta-analysis. Musculoskeletal Science And Practice, 31, 62-71. doi: 10.1016/j.msksp.2017.07.005
3.  Falla, D., & Hodges, P. (2017). Individualized Exercise Interventions for Spinal Pain. Exercise And Sport Sciences Reviews, 45(2), 105-115. doi: 10.1249/jes.0000000000000103