The posture adopted by some pianists predisposes them to overusage symptoms in the shoulder girdles and upper limbs. The use of an upright playing position with the keyboard at a height that allows the forearms to be at an approximate right angle to the upper arms would reduce the static loads on the muscles of the upper back and shoulder girdles — those muscles along the upper dorsal vertebrae, around the shoulder blades and at the junction between the neck and upper shoulders.

There is therefore a greater possibility for the products of metabolism of muscle to be cleared from muscles which must otherwise be adversely affected by the anaerobic processes that follow such overuse. A simple programme ensuring that long periods of practice are punctuated by movement and relaxation away from the keyboard should therefore be a high priority in the teaching of piano and other instruments where the muscles of the shoulder girdles are under constant tension.

Such programmes have been introduced by many concerned employers as an intrinsic part of the increased interest in occupational health and safety. Frequent periods of rest, or isometric exercise or even aerobics programmes are now common in a range of industries.

For those who play musical instruments in the upright position a proper awareness of the position of the body and limbs, as well as the head and neck should be taught. They should be aware of how they grasp their instruments and how excess tension in the muscles will lead to a deterioration in the quality of the music that they produce.

It must always be remembered that the ubiquitous lumbago or chronic back pain afflicts the majority of humans at some time in their life and that early intervention through improved body awareness and exercise is never introduced too early.

*80\37\8*

According to Canadian neurologist Prof. John Edmeads, speaking at the 4th International Headache Congress nine out of ten women and about seven in 10 men get headaches. In cases where the pain is so severe that it disrupts normal life, headache is no trivial thing.

Symptoms which could indicate serious disease include sudden onset, clouded consciousness, associated fever, scalp tenderness and the presence of other neurological symptoms.

In most chronic headache sufferers pathology tests will be of limited value. However the eyes should be checked with an ophthalmoscope to assess the condition of the back of the eyes for the presence of blood vessel abnormalities, or evidence that the pressure inside the head may be raised. The blood pressure must be measured and the patient’s field of vision should be checked.

CT scans can be used to exclude tumours or other causes of raised brain pressure.

About 95% of all headaches are said to be benign. In 1988 the International Headache Society classified headaches into 13 groups.

• Tension type headaches

• Migraine

• Cluster headache and chronic paroxysmal hemicrania

• Miscellaneous headache not associated with structural lesion

Headache associated with

• Head trauma

• Vascular disorders

• Non-vascular intracranial disorder

• Substances or their withdrawal

• Non-cephalic infection

• Metabolic disorder

• Headache or facial pain associated with disorders of the cranium, eyes, ears, nose, sinuses, teeth, mouth or other cranial or facial structures

• Cranial neuralgias, nerve-trunk pain and de-afferentiation pain

• Unclassifiable headaches

*57\37\8*

In recent times, doctors have increasingly come to recognise ‘Type A’ behaviour — which drastically increases an individual’s vulnerability to heart attack and other stress-related illnesses. Typically, such an individual tries to accomplish too many things in too little time. Such people have a low threshold to irritation. Even trivial things quickly upset them. However, for some individuals, quiet meditation twice a day can permanently lower blood pressure and achieve a necessary state of inner peace which may be reflected in changed behaviour.

Stress is commonly treated by medication such as tranquillisers, muscle relaxants, sleeping pills, stimulants, antidepressants and mood enhancers.

*36\37\8*

Birth of the placebo

The non-active substitute for medication — the placebo, meaning ‘I please’ — is not to be scoffed at. It works because the patient believes it works. The more sophisticated ‘sugar-coated pill’ of hard-pressed country doctors, with few resources, makes an important contribution to psychological factors in pain alleviation. It is now known that simply believing that a pill or potion is a powerful painkiller is enough to stimulate the brain to produce its own natural opiates.

*13\37\8*