Professional dancer Hannah Requa had a history of injuries, but it was excruciating hip flexor pain that forced her to seek help.
The perils of playingEric Nestler has played the saxophone on stages all over the world. But a few years ago, he was stopped cold by tremors that rippled down his jaw. His tongue contorted. The muscles in his neck tightened so much he could no longer play the music he loved. “I knew something was wrong,” he said. “But I had no control over it.” Focal dystonia, a condition characterized by involuntary muscle contractions, was stealing his ability to perform. Playing the saxophone, the instrument Nestler had dedicated hours to each day since middle school, was now destroying his career. Dr. Surve is the first person to say how much he appreciates music. But he knows, too, that playing it is a task that comes with risks: inflamed tendons, nerve damage, muscle pain, hearing loss. For pianists, it’s tendonitis. For trombone players, it’s left shoulder injuries. Singers can lose their voice. Even conductors endure pain from holding their arms above their heads. Focal dystonia affects an estimated 1 percent of all musicians and is triggered by repetitive movements. By the time Nestler, a music professor at the University of North Texas, came to Dr. Surve, he was desperate for relief. He’d gone to different doctors, considered Botox injections for his chin and tried acupuncture, which provided temporary help. But no treatment worked long term until he saw Dr. Surve, who used osteopathic manipulative medicine to ease the tension in Nestler’s jaw. “Now I have range again and am able to play in tune, whereas before I couldn’t do that.”-Eric Nestler Dr. Surve also suggested an unexpected treatment: playing another instrument. By retraining the brain to master a new task, musicians with focal dystonia are sometimes able to return to playing, Dr. Surve said. He suggested Nestler try the flute. “Playing the flute uses the same muscles as the saxophone, but in a different way,” Dr. Surve said. “As he gets better at playing the flute, he’ll get better at playing the saxophone again.” Nestler still has focal dystonia, but the treatment has allowed him to perform again. “Much of my energy is still devoted to not letting the tremors occur when I’m playing,” he said. “But now I have range again and am able to play in tune, whereas before I couldn’t do that.”
Under Dr. Sajid Surve’s care, Eric Nestler still has tremors, but he is able to perform again.
Knowing the vocabularyWhen Requa told Dr. Surve about her hip pain, his response caught her by surprise. He asked her to demonstrate her developpe, a move in which the leg is gradually unfolded and extended into the air. “He actually knows the vocabulary of dance,” Requa said. By observing her in action, Dr. Surve could determine the source of her pain and manipulate the pelvis to relieve it. Since then Requa has turned to Dr. Surve for other dance-related ailments. “He seems to just know why my hip is bothering me and then he calmly adjusts it,” she said. “He wants to keep you performing for as long as it’s possible and healthy.” Dancing is notoriously brutal on bodies. The annual injury rate for dancers is 75 percent to 95 percent, with more than 20 percent of those being hip injuries. “We know dancers are going to injure themselves. So we have to find ways to manage that.”-Dr. Sajid Surve “We know dancers are going to injure themselves,” Dr. Surve said. “So we have to find ways to manage that.” Requa is confident that with Dr. Surve’s help, she’ll be able to continue her career for a long time. “He knows how the body is supposed to be,” she said. “And he knows how to put it back together when it’s not.”
A misaligned tendon in Nabeel Zuhdi’s left thumb left him in constant pain.
The strain of strummingPain in his left thumb nearly became Nabeel Zuhdi’s undoing. A classically trained guitarist, he practiced five hours a day in between his job as a waiter. But the wear and tear on his thumb caused by carrying heavy trays and strumming his guitar left him in constant pain. “Not everyone gets injured, but if you are practicing four hours a day, six or seven days a week, and you are repeating the same motion, your body is going to get fatigued.”-Dr. Sajid Surve “It was all very devastating,” Zuhdi said. A graduate music student at UNT, he knew that injuries often plague musicians. He was even researching a study on the subject. He turned to Dr. Surve, who examined his hand and quickly determined that a tendon was misaligned, causing additional fatigue on the muscle. “He smashed the muscle using his hand,” Zuhdi said. “It hurt at the time, but after several days it got better.” The sharp pain that he had struggled with for years soon disappeared, and he resumed playing without pain. Repetitive stress injuries are among the most common for musicians, Dr. Surve said. “Not everyone gets injured, but if you are practicing four hours a day, six or seven days a week, and you are repeating the same motion, your body is going to get fatigued,” he said. Rather than focusing on the instrument a musician plays, Dr. Surve looks at the whole patient, from their posture to the way they move. Just as with sports, there are ways to reduce the risk of performance injuries. Along with colleagues at UNT, Dr. Surve has pushed for new standards that require colleges to inform students of the risks that come with performing. “Musicians need to take breaks and do stretching exercises to get their bodies ready to perform,” Dr. Surve said. “And they need to be able to recognize when there’s a problem.” That awareness could spare musicians the agony of injuries and the tendency to just push through the pain without getting treated, Zuhdi said. “It’s devastating to have an injury,” he said. “And it feels so good when you actually get relief.”