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Chiropractor helps relieve musicians' pain caused by repetitive stress

Saturday, June 24, 2000

By Andrew Druckenbrod, Post-Gazette Classical Music Writer

For many musicians, there is a fear that makes stage fright run screaming. Dreaded repetitive performance injuries can destroy careers and crush dreams. Ironically, the more you practice to get better at playing music, the more the quick, small movements on your instrument take their toll on your body. Pittsburgh Symphony's principal bassoonist Nancy Goeres faced those demons, with a severe injury resulting simply from playing the awkwardly held bassoon.

Chiropractor Jeffrey Cohen uses his pressure point technique on blues guitarist Ernie Hawkins, who has a chronic back problem caused by playing in the same position for hours. (Tony Tye, Post-Gazette) 

"It was devastating," says Goeres. "I was very afraid. I thought, 'I will never get out of this.' " Her predicament began five years ago, when a sharp pain developed in her back and neck on the right side stemming from the way she holds her bassoon.

"When I play, I always hold my hands so my shoulder is back a little bit, and I bend my right elbow," she says. "What's interesting is, a lot of bassoon players have left hand problems because the weight of the bassoon is actually on the left hand."

The pain got steadily worse, to the point that she could barely play. She took off six weeks and then saw a doctor. "I went to a shoulder expert at UPMC, and he concluded that he would do surgery," says Goeres. "He decided that since the bone didn't have enough room, then he would scrap away bone that was rubbing against muscle. It sounds terrible." Indeed. "He said, 'You'll only be out a week and then you'll be playing again,' " she says. "I didn't believe that. They don't realize how much pressure there is to play an instrument."

Goeres waited on the surgery and did physical therapy, but the problem persisted. Then a symphony member told her about someone who could help: local chiropractor Jeffrey Cohen, a man with no classical background whatsoever.

Cohen diagnosed Goeres as having muscle spasms in the back. "I had knots with the spasms, the muscles were totally tight," she says. "For two weeks I went to him every day and it was very painful. He does very specific technique of pressure points [which] releases toxins that gather in these pressure points." The result was staggeringly successful. "I had her back to work in three weeks," said Cohen.

Cohen, Squirrel Hill resident with a practice in Oakland, applies trigger-point therapy first developed by chiropractor Raymond Nimmo in the 1950s. It eschews moving bone in favor of soft-tissue treatment. Cohen, 54, is continuing to develop those techniques, which he uses on anyone from professional athletes to weekend warriors.

But musicians and their performance injuries have caught his interest lately. "Each instrument has its own problems," he says. "I get a kick out of it."

The treatment was so successful on Goeres that it prompted Cohen, a published researcher, to present it this morning at the Performing Arts Medicine Association annual symposium convening in Aspen, Colo., during the Aspen Music Festival. "I had never seen anything about a bassoonist in all the literature," he says. "I have a feeling that no one's come up with a treatment for it, so they haven't written about it."

When Cohen gives his paper, "Intractable Shoulder Pain in a Professional Bassoonist," he will have overcome a bit of an uphill battle of his own. "Jeffrey Cohen is the first speaker who actually is a [chiropractor]," says Dr. Alice Brandfonbrener, one of the founders of PAMA and a renowned researcher in this specialized field. Chiropractors have traditionally had trouble gaining the respect of medical doctors, but Cohen's not worried. "I know my stuff," he says. "I can explain it well." He has lectured before, including at the medical school at Pitt.

Prejudice may remain, but any qualified person can present at the symposium, according to Mary Fletcher, PAMA's executive director. "Abstracts are reviewed by a committee," she says, explaining it would be foolish for such a small field to be snobbish toward other disciplines. "Performing arts medicine is not a high-profile, well-funded medicine like orthopedic," she says. "It's a tough run."

Performing arts medicine in all its forms -- medical, chiropractic or otherwise -- deals with two basic categories: helping musicians recover from random accidents and helping them cope with performance-related injuries. The numbness and pain of the latter evolve in musicians who spend years playing instruments in ergonomically odd positions and repeating small movements.

Musicians fear the development of repetitive-use injuries more than they do a hostile audience. Many different solutions are prescribed: Surgery, performance-aiding tools, such as the Finger and Hand Retraining Ergonomic Device used to support the oboe while playing, and physical therapy among them. They often work, but not in Goeres' case.

She still occasionally goes to Cohen for maintenance. "I won't let that happen again," she says. "I am listening more to what my body is telling me." Luckily, the episode "has not affected my playing adversely."

Goeres is not the only local musician Cohen has treated. Among others, blues guitarist Ernie Hawkins and PSO principal horn player William Caballero also sought him out.

"I have a chronic back problem, so my problem is being in a certain position for hours," said Hawkins of playing the guitar. "Jeffrey's trigger-release method releases those spasms. I come back every week. It's enabled me to keep going, for sure. There are doctors, medical practitioners and people that are healers. Jeffrey is a healer."

Caballero gets treatment for his lips and jaw. "Playing a brass instrument is foreign. You have to vibrate your lips -- that is your reed," he says. "[I had] some nerve blockage and blood flow that he was able to improve.

"I know a lot of people do have doubts about chiropractors, but I think they are familiar with anatomy and how it affects us physically. [Cohen's] knowledge, and his concern, were apparent. We were on the same page immediately."

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