Violinist with neck and left arm pain

history
   

Evaluation on 10/31/17

Problem:

22 year old violinist is not sure he will be well enough to participate in his rehearsals and two performances of two 15-minute programs, due to symptoms.

Main complaints:   

6-7/10 numbness/discomfort in left arm

Occasional tingles into left hand

Chronically tense neck

Headaches

Medical diagnosis: 

“Temporary neck seizures or migraine”

MRI taken November 2, the next day after the performances

Nothing clinically significant found

Significant Findings

Forward head posture - which makes head tilt back
Shoulder blades "depressed" (too low)
Kyphosis - excessively rounded upper back
He bends from his spine too often and too much, rather than from his hips 

movement system diagnosis

Cervical Extension syndrome:  His head deviates forward too much

Scapular anterior tilt:  His shoulder blades are titled forward too much

Scapular depression:  His shoulder blades lie too low

Treatments: exercises

- Head retraction exercise to decrease forward head and cervical extension
- Walk without letting trunk collapse and head to come forward
- Arm raises to elevate and posteriorly tilt scapula
- Train to move from hip joints, not neck or back, for bending forward while sitting and standing.

treatments: Strategies

- Identify all the alignments and movements that increase symptoms, and try to eliminate them.
- Work on computer without collapsing from spine.  (Avoid working in bed, or make it more suitable.)
- Modify chin/shoulder rest height
- Increase height of music stand
- Alter alignment and movements as soon as symptoms come on, in order to diminish them.  
- Use a timer when using computer to take measured breaks.  On the break, do the arm raise exercise and/or head retractions to reverse the effects of poor posture.

outcome

Nov 15

"I am doing very well.  Here are my answers to the questions:
1. I can tell for sure that my tendency to elevate my left shoulder has aligned my upper body in a way that causes temporary pain in neck and left arm. 
2. I think exercises - especially doing frequent head retraction - had a lot to do with my improvement. I realized now I tend to play in a more neutral position, with chin barely touching the chinrest.
3. Taking a break more often while practicing/rehearsing seems important. Now I take a break every half an hour."

Dec 4

"Now I can say with assurance that these symptoms were results of sustaining body positions that are not neutral, for they gradually disappeared as I worked with you on neutralizing my neck and arm positions. When I first experienced left arm discomfort was when the intensity was highest, probably 6~7 out of 10. During rehearsals in Caramoor, the symptoms relieved, maybe to 3~4."

Dec 13

"1. The headache only lasted for a day or two when I first felt the symptoms. I think I was so frightened at first and that the headache had to do more with some psychological fear....?

2. My doctor's diagnosis was migraine (which happens without headache) and neck seizure: he thought migraine was more probable, as neck seizure rarely occurs to someone in my age.
I think my arm is fully recovered now. I will update you whenever discomfort reoccurs."

images

Rounded back led to a forward head

Low Music stand Caused symptoms

              Raising music stand alleviated symptoms