We’ve all heard it before: no pain, no gain. No wonder so many of us push our bodies to the max and end up paying for it later. Pain a warning signal. And pain during or after playing is a sign that something has gone, or is likely about to go, wrong.
Drumming requires hours of practice and physical repetition. It takes muscle conditioning, endurance, strength, and coordination. All of that can put tremendous ongoing strain on your body. As a result, an increasing number of drummers are sustaining overuse injuries to their wrists, arms, elbows, shoulders, knees, and spines.
Overuse injuries are result of repetitive microtrauma to bones, muscles, ligaments, and joints. These injuries develop over time and often present subtly at first. They can occur throughout the body, affecting a variety of tissue including: tendons (producing tendonitis), bone (producing stress fractures), bone-tendon, and bone-ligament junctions (producing instability). Common examples include: tennis elbow (lateral epicondylitis), carpal tunnel syndrome, cubital tunnel syndrome, patella tendonitis of the knee, shin splints, Achilles tendonitis, rotator cuff impingement and shoulder instability syndromes, and lumbar and cervical spine strain.
Overuse injuries occur from the repetitive application of submaximal stress to normal tissue. This happens when the fine balance between tissue breakdown (due to practice) and tissue recovery is disrupted. Simply put, the tissue breakdown occurs more rapidly than the tissue buildup or recovery, leading to injury.
A number of intrinsic and extrinsic factors can play a role. Intrinsic factors include: anatomic alignment (leg-length differences, hip rotation, foot deformities), growth, muscle-tendon imbalance, and underlying diseases (including chronic disease and previous fractures or injuries inadequately treated or rehabilitated). Extrinsic factors include: training errors, environmental, and equipment factors.
Training errors are the most common and develop when a drummer increases the volume, duration, and/or intensity of an activity too quickly. This results in inadequate recovery time, preventing the proper tissue adaptations from taking place. Training errors typically occur early on, when new skills are introduced stressing different tissues, or when practice intensity is increased too rapidly. However injuries can also occur when a player is pushing toward peak performance, and tissues are close to their ultimate breakdown point and more vulnerable to injury.
Inadequate or poor technique can also place abnormal stress on musculoskeletal tissue, as can improperly fitting or inadequate equipment. For example, crash cymbals that require too much reach can strain the shoulders, while a throne positioned too high or low can put stress on the ankles, knees, and spine. Environmental factors such as playing surfaces and acoustics can also play a role.
The diagnosis of overuse injuries can only be made by a physician conducting a thorough history and physical examination. Some cases will require additional diagnostic testing such as X-rays, bone scans, MRI studies, or nerve testing.
The treatment will depend on the specific injury diagnosed. Treatment might include oral medications and physical therapy. Decreasing the intensity, duration, or frequency of the offending activity may also be recommended. Careful attention to technique, working with a teacher, paying attention to proper warm-up and cool down, in addition to the application of ice after practice or performances are also beneficial.
The majority of overuse injuries can be prevented with proper training and common sense. There is no truth in the saying “no pain, no gain.” Drummers must learn to listen to their bodies and recognize the early signs of over-practicing.