What is the recommended treatment for neck injuries in musical performers?

Treatment of Neck Injuries in Musical Performers

The recommended treatment for neck injuries in musical performers should follow a graduated, methodical plan that begins with pain reduction followed by a structured return to musical activities to prevent relapses and optimize recovery outcomes. 1

Initial Assessment and Diagnosis

• CT angiography (CTA) is the first-line imaging modality for evaluating neck injuries when immediate surgical intervention is not required, with high sensitivity (90-100%) and specificity (98.6-100%) for detecting vascular injuries 2
• MRI is valuable for evaluating spinal cord injury, traumatic disk injury, ligamentous injury, and blood within the spinal canal in stable patients 2
• For musicians, diagnosis is greatly facilitated by examining the patient while they play their instrument to observe playing posture, trunk stabilization, and technique 3

Treatment Algorithm

Phase 1: Pain Reduction and Acute Management

• For unstable patients with hard signs (active hemorrhage, expanding hematoma, hemodynamic instability), immediate surgical exploration is indicated 2
• For stable patients with soft signs (nonpulsatile hematoma, dysphonia, subcutaneous emphysema), imaging-guided management is appropriate 2
• Initial treatment modalities include:
  • Relative rest with avoidance of aggravating activities 1, 3
  • Ice application for acute inflammation 4
  • Pain management with appropriate medications 5

Phase 2: Rehabilitation

• Osteopathic medicine has shown effectiveness in reducing pain intensity in musicians with chronic neck pain, with significant improvements maintained up to 52 weeks 5
• Physical therapy focusing on:
  • Posture correction and ergonomic adjustments specific to the instrument 3
  • Neck muscle strengthening exercises, as higher neck strength is associated with reduced head impact magnitude 2
  • Core stability training, which is particularly important for musicians' injury prevention 3

Phase 3: Graduated Return to Playing

• Implement a structured "work hardening" approach with gradual increase in:
  • Duration: Begin with very short playing sessions (5-10 minutes) multiple times per day 1
  • Intensity: Start with simple, less demanding musical passages 1
  • Technical difficulty: Gradually reintroduce more complex techniques 1
• Mental practice techniques should be incorporated to maintain technical capabilities during periods of reduced physical playing 1, 3

Special Considerations for Musicians

• Playing posture assessment is essential, as faulty posture is a common cause of musicians' injuries 3
• Hypermobility is both an asset and risk factor for musicians and requires special attention in treatment planning 3
• Practice habits should be modified to include regular breaks (10-15 minutes each hour) 4
• Stretching before playing is recommended, as 75% of uninjured musicians report this practice 4

Common Pitfalls and Caveats

• Never advise a musician to completely stop playing as this can be psychologically devastating; instead, implement relative rest with mental practice 3
• Be aware that musicians often continue playing despite pain, which can worsen injuries 4
• Longer practice hours correlate with increased injury incidence, so monitoring and adjusting practice duration is critical 4
• Minor setbacks during recovery should be anticipated and communicated to the patient to prevent discouragement 1
• Early specialized medical assessment is essential to rule out specific injuries that may require different treatment approaches 3

Prevention Strategies

• Regular physical fitness activities, with most musicians benefiting from exercise 1-3 days per week 4
• Implementation of specific neck muscle training programs as part of a comprehensive neuromuscular training approach 2
• Education about proper technique, especially for activities that place stress on the neck 2
• Regular breaks during practice sessions to prevent overuse injuries 4