Why Should We Exercise?

Their are numerous benefits to regular exercise. You may say as drummers or percussionists you get enough exercise with practicing or performing. Unfortunately, this can be a common misconception.

Regular physical activity and exercise are beneficial and extremely important for long-term health and well-being. Regular exercise can help protect us from heart disease and stroke, diabetes, high blood pressure, osteoporosis and obesity. There are also psychological effects of regular activity including improvement of our mood and management of stress.

Exercise and physical activity can be achieved in various ways. The various forms of exercise also bring specific benefits with each method. Exercise can be broken in aerobic exercise (cardiovascular, cardio) or strength training.

Aerobic exercise 20 to 30 minutes three to four times a week combined with some form of strength training and stretching at least twice a week have been shown to provide the greatest overall health benefits. For those of us that are unable to perform this level of activity, substantial benefits can be gained with 30 minutes or more of moderate intensity activity per day five times a week. Start slow and gradually increase the time and intensity of your physical activity. Starting out slow allows you to improve your fitness level without placing tremendous stress across you joints and muscles.

Aerobic exercise will improve cardiovascular (heart) and cardiopulmonary (lung) functions, increase maximal oxygen consumption (VO2max), lower heart rate and blood pressure, increase blood supply to muscles, increase good cholesterol (HDL), decrease blood triglycerides, reduce body fat and decrease body weight.

Forms of aerobic exercise include: walking, jogging, swimming, bicycling, climbing and jumping rope.

Strength training using weights, machines, resistive bands or medicine balls on a regular basis will increase overall muscle strength, increase tendon and ligament strength, improve joint and muscle flexibility, reduce body fat and increase lean body mass and improve balance and overall functional ability.

As you can see regular exercises greatest benefit might be improving our overall quality of life.

**If there are any health related topics that you would like to learn more about or like me to discuss in the upcoming year please email me with your topics or questions and I will be happy to bring those to you.

Feeling the Vibe!

As we all know, playing the drums is a very physical activity. The shear forces and repetitive motions that occur with drumming can result in a number of maladies and physical injuries to the upper extremities, lower extremities and spine. Most of the injuries that occur due to drumming can be prevented or avoided with proper posture, technique, keeping our muscles and joints flexible and strong, by practicing proper warm-up and cool-down and by maintaining a relatively ergonomic posture. However, they’re are other factors that might affect our health without us realizing there adverse affects, particularly those associated with vibration.

Continuous exposure to vibration has been shown to cause a variety of health problems such as back pain, carpal tunnel syndrome, and vascular disorders.

Vibration exposure can be classified into whole-body vibration exposure or hand and arm vibration exposure. The various types of vibration can have different sources, affect different areas of the body, and produce very different symptoms.

Exposure to hand and arm vibration is limited to the hands and arms and was originally described in workers that used power hand tools such as jackhammers. I have noticed with greater frequency in my medical practice drummers being evaluated with signs of hand and arm vibration exposure. This I feel is a direct result of the continuous repetitive motion of the hand and wrist involved in the act of drumming in addition to the constant vibration that is transferred from the drum stick to the hand.

Whole-body vibration occurs with vibration transmitted to the entire body through the seat or from the feet, or a combination of the two. This potentially can occur in musicians through standing on vibrating floors or sitting on a vibrating seat.

The health effects of vibration exposure in drummers can result from extended periods of contact between a drummer and the vibrating surface they are exposed too. Drummers particularly are at risk since they can be exposed to vibration through multiple body parts such as the hands-stick-drum head, feet-pedals-base drum head and or hi hat or from the buttocks-seat-floor interfaces.

Drummers can develop symptoms including back pain, diminished sensation and dexterity in the hands or feet, decreased grip strength, vascular injury resulting in finger blanching or “white fingers”, tendonitis’ or a variety of nerve entrapment neuropathies such as carpal tunnel syndrome.

Whole-body vibration levels can often be reduced by using vibration isolation or by utilizing suspension systems between the drummer and the vibrating source such as using a cushioned drum throne.

Hand and arm vibration may be more difficult to control. Vibration levels depend on numerous properties including size and weight of the drumstick, hand grip, handle location on the stick, and drum head tension or cymbal density. Primary prevention through eliminating excessive vibration and shock can be accomplished potentially through better ergonomic drumstick design or by cushioning of the hands by wearing gloves or wrapping sticks with a vibration absorbing material. Drumsticks have also evolved over the last few years with manufacturerers experimenting with different stick shapes, materials as well as dipped or coating sticks for better grip.  A number of stick manufacturers have now introduced anti vibration sticks, which they claim will reduce vibration to the hands.

Next months article will take a closer look at these anti vibration sticks and the data that supports their efficacy as well as how we can recognize the affects of vibration exposure and prevent further injury due to vibration.

Dr. Luga Podesta is an Assistant Clinical Professor of Physical Medicine & Rehabilitation, practicing orthopedic sports medicine and rehabilitative medicine in Thousand Oaks, California, specializing in the non-surgical treatment of the upper extremities, knee, and spine. He is a sports medicine consultant and team physician for Major League Baseball’s Los Angeles Angels and serves as head team physician for the Los Angeles Avengers of the Arena Football League, Los Angeles Riptide of Major League Lacrosse and is a drummer. Dr. Podesta can be reached at lugamd@aol.com

Hand and Wrist Injuries

As drummers and percussionists we all know, our art can take its toll on our hands and wrists. Repetitive gripping of drum sticks or striking a drum with our hands can lead to a number of injuries to the fingers, joints, tendons and muscles within the hand and wrist. Drummers and hand percussionists can develop pain in the palm of their hands or within their fingers, which can be debilitating.

The human hand and wrist are an amazing work of anatomy, intricate in it’s design and function. Injury to the underlying structures of a musician’s hand or wrist potentially predisposes them to serious handicap and functional impairment.

Anyone with a hand injury, drummer or not, should consider seeking medical attention as quickly as possible. The potential for devastating injuries increases greatly when medical attention is delayed. Even the smallest cut or seemingly innocent hand injury could require advanced treatment to prevent significant loss of function.

The hand and wrist consists of 27 bones. When the other structures of the hand and wrist including the numerous nerves, arteries, veins, muscles, tendons, ligaments, and cartilage are considered, the potential for a variety of injuries exists when this intricate structure is subjected to repetitive or direct trauma.

The symptoms of hand and wrist injuries can vary depending on the type of injury, the mechanism of injury, the severity, and location. Common symptoms range from pain, swelling, numbness, stiffness, discoloration of the skin, weakness, deformity, localized warmth or redness, blistering, loss of motion or catching and clicking. Specific hand or wrist injuries will present with one or more of these symptoms. Unfortunately, many hand and wrist injuries are felt to be trivial or minor in nature and are not treated early enough. The majority of conditions involving the hand and wrist can be treated non-surgically. However, when they become chronic or the condition worsens, then some ultimately will require surgical treatment to restore normal function.

Over the next few issues of DRUM I will cover some of the more common overuse and traumatic injuries to the hand and wrist including: nerve compression injuries such as carpal tunnel syndrome and ulnar neuropathy; tendon injuries including De Quervain’s syndrome, trigger finger, wrist tendonitis; fractures involving the wrist and fingers; and finally ligament and cartilage injuries including finger dislocations and sprains, ganglion cysts, and triangular fibrocartilage complex injuries. The remainder of the articles will touch on maintaining excellent hand and wrist health and prevention of these potentially devastating injuries from occuring.

How to Find the Right Doctor for You

As a physician I am often asked by my patients, how do you know if a physician is good, or they will say, I have been to a number of physicians before I found one that I liked or that cares about me. As a medical consumer it is very difficult to know who is qualified, who will take the time to listen to your problems and who will make the right diagnosis and provide the correct treatment.

Finding a good physician or the right physician is not easy. It will take some time and effort on your part but will be well worth your time and effort when the right doctor has been identified. You will need to find a physician that you can trust. However, feeling comfortable with a doctor isn’t enough. There are several other critical elements that must be taken into consideration before making that important decision. Here are some helpful tips for finding a qualified physician.

Word of mouth is a very effective way to find a suitable physician. The vast majority of my practice has been built on patient-to-patient referrals. Asking family and friends whom they see for general or specialty medical care is a very valuable method. Get recommendations, from sources you can trust. If family and friends can willingly recommend physicians they have visited, call those physicians’ offices to find out if they will accept new patients. Then schedule a first-time patient evaluation to become familiar with the physicians style and range of services. If you do not care for his or her manner, start looking again. Other potential sources for Doctor referrals are your local hospital referral service, or simply look at your health plan physician directory. Most importantly, find out if your doctor is board certified. Board certification is absolutely critical. Without it, you won’t know if the physician has had proper training in that field of specialty. This is important because in this country, physicians, once licensed, can market they practice a specific specialty – whether or not they’ve had specific training in that specialty.

Check your local yellow pages listing in the telephone book. The telephone book’s yellow pages, or commercial listings, include a section for “Physicians” that breaks down into specialty areas, like “Orthopedics” or “Sports Medicine.” If you cannot find the specific type of listing you are looking for, check for a local city or county medical society or association that may be able to assist you with helpful information.

According to WebMD, a leading source of online medical information, a good doctor should: have credentials (board certification, certificate of added qualification, fellowship training etc), have the background to meet your needs (was or currently is a musician, former athlete stc.), takes steps to prevent illness instead of just treating it, has access to a good hospital, is a participant of your health car plan, encourages you to ask questions, listens to what you say and your concerns, treats you with respect and communicates well. Communication is very important. A good physician should never brush off your questions, no matter how “ridiculous” they may be. Many doctors are busy, but they should take the time to answer all your questions. After your first visit, take some time to evaluate how things went. Your doctor should make you feel comfortable, answer all your questions and under no circumstances make you feel dismissed.

You can also acquire a great deal of information on a potential physician by searching the web. The web can tell you information about each medical practice you are reviewing, including the physicians name, specialties, office hours, insurance information, and other details. You can also go to a search engine and type in the medical specialty you are looking for, along with your state’s name. There are a number of web sites that can be helpful and informative including: American Medical Association’s website at Ama-Assn.org, the website of the American Board of Medical Specialties (ABMS), your State Medical Board and your local city or county medical society web sites.

Getting the name of a qualified physician who can help you is not particularly difficult, but it can take time and some effort. The results will be worth the effort spent when you find that physician who you are comfortable with and have confidence in and who can best treat your symptoms with favorable outcomes.

“I Can’t Hear You!” What every drummer needs to know about hearing protection.

Luga Podesta, MD & Helena Espinoza, PA-C

Musicians, particularly drummers, are at risk for losing their hearing as a result of playing without proper ear protection.  Sixty percent of Rock and Rock Hall of Fame inductees are hearing impaired. Hearing damage can present as a temporary or permanent ringing in the ears, called tinnitus, or as a short or long-term loss of the ability to hear clearly caused Noise induced hearing loss.  Noise-induced hearing loss is caused by chronic exposure to sound levels that exceed 85-90 dB, particularly in the frequency range around 4,000 Hz, causing sensorineural impaired hearing. Playing drums or listening to loud amplified music without ear protection usually exposes you to 100-115 dB.  The risk of developing hearing loss depends on the length of time of exposure without ear protection, the proximity to speakers, listening to loud music through earphones, previous hearing damage, and you physical condition.  It takes only 15 minutes of noise exposure of 100-115 dB without ear protection before you may begin to damage your hearing.

Often, this problem goes unnoticed for long periods of time because speech frequencies, which are 500-4,000 Hz, are initially unaffected.  Therefore, you may not experience difficulty with hearing during a normal conversation. At first, there is a temporary threshold shift, in which there is a reversible elevation in the threshold for sound perception. Over time, if sound levels above 90 dB persist, this threshold shift will become permanent.

The drummer who may be developing hearing loss may experience a sensation of ear fullness or pressure. Also, if you think you have grown used to loud noise, it has probably damaged your ears. At this point, it is vital to protect what remaining hearing you have because there is no treatment, no medicine, no surgery, not even a hearing aid that can correct your hearing once it is damaged by noise.

If you suspect that you are developing noise-induced hearing loss, ringing in your ears, difficulty hearing in the presence of background noise, conversation sounds mumbled, the need to turn the volume of your TV or MP3 player up or hearing a telephone better with one ear than the other, it is important to see your physician for a physical exam, a screening for hearing loss, and several hearing tests. The American Academy of Otolaryngology has developed a simple one-page test that the musician can self-administer to determine if a hearing evaluation by an otolaryngologist (ear, nose, and throat physician) is necessary. To find this test, visit http://www.nsslha.org/public/hearing/disorders/Self-Test.htm.

Ear protection to avoid exposure to continued noise exposure is the only way to prevent noise-induced hearing loss. Earplugs (fig. 1) are small inserts that fit into the outer ear canal. To be effective, they must totally block the ear canal with an airtight seal, snugly fitting to the circumference of the canal. Properly fitted earplugs or muffs (fig.2) reduce noise 15 to 30 dB. They are available in a variety of shapes and sizes to fit individual ear canals and can be custom made. Simple foam ear-plugs are available at very low cost at most music stores. Custom made earplugs can be obtained from audiologists. An improperly fitted, dirty or worn-out ear plug can irritate the ear canal and may not seal properly. Ordinary cotton balls or tissue paper wads pressed into the ear canals are very poor protectors and may only reduce noise by only 7 dB. The better earplugs and muffs are approximately equal in sound reduction, although earplugs are better for low frequency noise like music produced by drummers or bass players. In-ear personal monitoring systems (fig. 3) provide quality stereo sound, eliminating external background noise. These devices allow the musician to hear exactly what the instrument produces, however, if the in-ear monitor volume is too loud, these too can be harmful to the ear.

We know that the more we practice, the better we will play, but keep in mind that it is impossible to be a successful musician if you cannot hear the music.

I Think I have a Pinched Nerve

Have you ever experienced an electrical shock like pain down your arm or leg? Or have you ever awoke from a nights sleep with numbness or tingling in your arm or leg? These are common symptoms of a “pinched nerve”. A “pinched nerve” is a description for a number of injuries or conditions that can affect nerves in the neck, low back or within the upper or lower extremities. Common names include sciatica for pain in the legs, cervical or lumbar radiculopathy in nerves exiting the neck (cervical) or lumbar (low back) spine. Nerves can also be pinched in the upper extremity as in carpal tunnel syndrome in the wrist or cubital tunnel syndrome in the elbow. A “pinched nerve” is the term for pain or impaired function of a nerve that is under pressure. It happens to nerves that control muscle movements or relay sensations to the brain.

Initial symptoms of a :pinched nerve” may include numbness, tingling, a burning sensation or sharp electrical pains down the legs from the low back or from the neck into the shoulders, arms and fingers.

Commonly, the pains and or abnormal sensations are experienced distant from the point of pressure. For example, a “pinched nerve” in the neck may cause pain in the wrist or hand as the only symptom. When the nerve is being damaged from constant pressure, pain and numbness may increase and weakness can develop in those muscles supplied by those particular nerves. There may be a loss of deep tendon reflexes, movement of a particular body part, sensation in the affected area, and shrinking (atrophy) of the affected muscles.

Nerves are extensions from the brain that reach out into the arms or legs and supply the electrical input and output to the muscles or skin. Nerves are similar to insulated electrical wires that transfer the electrical impulses from the brain to the muscles (motor nerves) or skin (sensory nerves). A nerve is a cell that is microscopic in size, and its fibers may run several feet in length toward its destination.

If a nerve gets “pinched” the flow up and down the inside of the nerve is reduced or blocked and the nutrients stop flowing. Eventually the membrane starts to loose its healthy ability to transmit the tiny electrical charges and the nerve fiber may eventually die. When enough fibers stop working, the skin may feel numbness or a muscle may not contract.

Common causes of “pinched nerves” in the cervical or lumbar spine include herniated discs, bulging discs or degenerative disc disease. Other causes include compression of a nerve in the arm, at the elbow or wrist, from repetitive movements, nerve instability or subluxation, maintaining a prolonged position or posture, arthritis, bone spurs, or a tumor or mass.

The treatment of a “pinched nerve” will be dependent on which nerve is compressed or damaged and how that nerve is actually being damaged. Treatment can be a simple as changing the position of the body part where the nerve is being pinched or as complicated as surgically decompressing the nerve (relieving the mechanical pressure). When you suspect a nerve is injured or possibly being compressed or “pinched”, it is important that you seek a medical evaluation as soon as possible to determine the cause of the symptoms before permanent nerve injury occurs.

Drummers are not immune to nerve injuries. In fact, it has been my unfortunate experience to have to treat an ever-increasing number of drummers with nerve related injuries. It is imperative that we take proper precautions such as warming up and cooling down before and after playing as well as maintaining an ergonomic set-up of our drum kits. These simple procedures can help to prevent these injuries from developing.

Dr. Luga Podesta practices orthopedic sports medicine in Thousand Oaks, California, specializing in the non-surgical treatment of the upper extremity, knee and spine. He is a sports medicine consultant and team physician for the Los Angeles Angels, serves as head team physician for the Los Angeles Avengers of the Arena Football League, Los Angeles Riptide of Major League Lacrosse, ans is an avid drummer. Dr. Podesta can be reaches at lugamd@aol.com.

I Think I Have an Itis in My Foot

Drummers rely on there feet to play effectively. Various genres of music are more demanding on the feet than others placing that drummer at risk for developing a variety of repetitive stress injuries to the supporting muscles and tendons. Tendon injuries can develop in any of the tendons that run across the ankle and foot. Most commonly injuries that develop are inflammation or partial tearing of the Achilles tendon (Achilles tendonitis) or from an inflammation of the plantar fascia (plantar fascitis). Both can be quite painful and debilitating to a drummer.

The Achilles tendon is the large tendon at the back of the ankle that connects the large calf muscles (Gastrocnemius and Soleus) to the heal bone (calcaneus), providing the power in the push off phase of the gait cycle or to push down on the kick pedal. Whether you play heel up or heel down, the Achilles tendon is active and/or stretched. The Achilles tendon shortens or contracts to push the foot down while playing heel up. The Achilles tendon stretches when the foot lifts off the pedal in the heel down position.

The Achilles tendon can become inflamed most commonly from overuse as well as from a number of other contributory factors. The Achilles tendon has a poor blood supply, making it vulnerable to injury and slow to heal. Achilles tendonitis can be acute or chronic. Acute Achilles tendonitis may be the result of overuse, practicing or training too much, too quickly.

Symptoms of Achilles tendonitis include pain in the back of the ankle during activity or exercise. Achilles pain will gradually develop with prolonged exercise but will go away with rest. Swelling over the Achilles tendon is a common finding and may be associated with redness over the skin.

Chronic Achilles tendonitis may often develop from acute Achilles tendonitis if the acute tendon injury is not treated properly or allowed to heal. Chronic Achilles tendonitis is a difficult condition to treat and can lead to tearing. The pains experienced during the acute phase of the injury tend to disappear after a warm up but return when activity has stopped. Eventually the injury and pain become so severe that it is difficult to walk and difficult to point the foot up or downward.

Plantar fasciitis is an inflammation of the arch of the foot between the heel and the ball of the foot. There a several possible causes of plantar fasciitis including wearing higher heeled shoes, weight gain and increased repetitive use of the foot. You are also more susceptible to developing plantar fasciitis if your arches are abnormally too high or low.

Plantar fasciitis will typically cause pain in the arch of the foot or close to the heel when you first get out of bed in the morning or after you get up from a seated position and take your first few steps. Pain occurs from stretching out the tight plantar fascia when the foot is placed on the floor and lessens after walking.

Treatment for Achilles tendonitis and plantar fasciitis can be difficult. Rest from the activity causing the injury is the first line of treatment. Strecthing the plantar fascia at night while sleeping in addition to while awake will help diminish the tightness experienced after rest. The application of cold therapy or ice for fifteen minutes every 2 to three hours can be extremely helpful. This is easily accomplished with an ice cup applied to the painful achilles tendon or by rolling the painful arch over a frozen water bottle. Wearing a felt heel pad to raise the heel and relieve strain off the Achilles tendon or the use of orthotics to support the arch can also provide relief. Stretching exercises for the Achilles tendon complex and plantar fascia are very important. Physical therapy is utilized in those cases that do not respond to early treatments. The judicial use of non-steroidal anti-inflammatory medications can also be beneficial.

The goal of early treatment of these itisis is to limit the duration of the acute stages of tendonitis and plantar fasciitis and to prevent Achilles tendon or plantar fascia rupture from occurring which will stop an active drummer in his tracks.

If I Only Knew Then What I Know Now!

I have had a very rewarding career as a Sports Medicine Physician over the past 27 years. I have had the opportunity to care for some of the world’s greatest and most famous athletes and have participated in the care of these athletes at the pinnacle of their careers, in front of thousands of fans. Performing these duties has never really phased me a great deal. This past summer I had the opportunity to stand on stage at Giant’s Stadium for the last performance of Bon Jovi’s “Have A Nice Day” tour. As I stared out at the sold out stadium of screaming fans I couldn’t help wonder if I had the opportunity would I have done something differently in life. During my high school and college days I was a fairly accomplished saxophonist and clarinetist and had aspirations of making music my career. During college, my interest began to turn towards medicine and eventually I attended and graduated medical school, completed my residency in Physical Medicine and Rehabilitation and two post-graduate Sports Medicine Fellowships. During that time and up until December 2001 I had not picked up my horns and to my disbelief, forgot how to read music. Granted, I could still play them, I just couldn’t read any longer. By this time I had a burning desire to learn to play the drums and get back into music. In December of 2001, I received a phone call from Gregg Bissonette who had given my name by the Los Angeles Dodgers. He came in as a patient, we became friends, he sat me down at the kit and my drumming career began.

Over the past 6 years I have had the opportunity to treat as patients some of the industries greatest drummers. It became quite evident that like the athletes I have cared for, these now middle age drummers were having the same orthopedic medical issues, such as rotator cuff tears, disc herniations, arthritis in every imaginable joint and other soft tissue conditions. During their visits I would often ask why do you think this has happened or what might have predisposed you to developing the problems that they were suffering from. It was from these conversations I realized that these interesting and influential individuals and drummers might be able to make a difference in a young musicians life. So I posed the question to Gregg Bissonette, Liberty DeVitto, Carmine Appice, Doane Perry, Myron Grombacher, Dave Weckl, and Jasson Bittner, “If you only knew then what you know now” what would you have done differently from a medical, social, family and personal stand point. If their collective wisdom and experiences could make a positive impact on a young drummers career or life and possibly prevent an injury or making the wrong choice, this article has served it’s purpose.

Gregg Bissonette is best known for his ability to play in a wide variety of styles. Gregg was born on June 9th, 1959, in Detroit, Michigan and later attended North Texas State University in Denton Texas where he became the drummer in the famed NTSU One O’Clock Big Band. After graduation from North Texas State University, Gregg became the drummer for Maynard Ferguson’s Big Band and moved to LA in 1982. Gregg has played with David Lee Roth, Joe Satriani, Gino Vannelli, Tania Maria, Brian Wilson, Robin Zander, Ringo Starr, James Taylor, Toto, Ray Charles, Don Henley, Santana and many others. Gregg got me started on the drums; he is a wonderful teacher and I credit him for any of the drumming ability that I posses which is not much.

Gregg Bissonette: Hello Drummers, I feel VERY strongly about this “If I only knew then what I know now” statement. In my junior high, high school, and even college days, I NEVER REALLY understood what it meant to COMPLETELY put the groove first. I would think about which beat I was about to play, or a certain fill I would do, but THE MOST IMPORTANT PART about playing drums I believe is focusing 100% on making sure that you are IN the groove and REALLY making the groove feel the best you can.

Now whenever I pick up the sticks, my #1 goal is to make people dance and feel good with the groove (this can be in ANY style). It makes me so happy to feel that I might be able to bring people joy with a groove. That is really what it is all about. I also wish I had warmed up for a few really big shows I did when I was in my twenties, instead of hanging out and schmoozing with friends and family an hour before the show. I always warm up really well now, but there were a few shows years ago that I know could have been better if I was completely warmed up!! God Bless all the drummers of the world…we can make people dance

Liberty Devitto was my inspiration to become a drummer. We grew up around the block from each other in Seaford, New York and attended Seaford High School. I was a few years younger but still have vivid memories of Liberty practicing in his back yard. Born August 8, 1950 in New York City, New York) of Italian ancestry, Liberty is an American rock drummer. Liberty taught himself to play the drums after seeing The Beatles on their appearance on The Ed Sullivan Show in 1964. In 1968, the same year he graduated high school, Liberty had the opportunity to play with Mitch Ryder. Throughout the seventies, eighties, nineties and up until the most recent 2006 tour, Liberty DeVitto has been the drummer for Billy Joel, the Hit Squad and has been a session drummer on recordings for many other artists.

Liberty DeVitto: From a medical standpoint I would have Protected my hearing. I have lost all high-end hearing. I didn’t care about the hearing loss when I was younger, I was having too much fun. Now I need to wear head phones just to hear the TV. You must workout! Keep your body at tiptop condition. From a lifestyle standpoint, I could have done without the artificial stimulants. Drugs and alcohol destroy, not create. From a family standpoint, traveling on the road separates you from your family. Still, I feel I was a good father and an ok husband. There is really nothing you can do about the separation. It’s the toughest part about going on the road. You hate to leave but you love to go away. It’s where the money is. You are helpless when something is wrong at home and you are a thousand miles away. I have been divorced twice and have had to build my relationship with my daughters. It’s getting better. Finally, from a social standpoint I have always stood strong and never compromised my belief in God, Country, or Family.

Carmine Appice was born December 15, 1946, in Staten Island, New York and first came to prominence in the late 1960s as the showy percussionist with Vanilla Fudge. Carmine is known for his showmanship, which includes stick tosses and twirls, power fills, and double-bass drum bombs. After five albums, Carmine and bassist Tim Bogert left Vanilla Fudge to form the blues-rock quartet Cactus. After leaving Cactus, Carmine and Bogert joined Jeff Beck and became the trio Beck, Bogert and Appice.

Carmine later joined Rod Stewart playing drums on and co-writing such Stewart hits as “Do Ya Think I’m Sexy?” and “Young Turks.” He was a member of the supergroup KGB, and has recorded with Stanley Clarke, Ozzy Osbourne, Ted Nugent, and Pink Floyd. He has also played in the bands King Kobra and Blue Murder.

Carmine Appice: Well I learned a lot in my career. A lot about my hearing, about career moves about staying healthy. Many, many things. Even about getting married to many times. So let me see if I can relay some of this to you.

I started my career with a successful first album from my group Vanilla Fudge in 1967. That was when all progressive music was underground and virgin. I guess we WERE ALTERNATIVE at that time. We had a first album that was almost Platinum in sales. We toured with the greatest Rock acts of the century Jimi Hendrix, Cream, and The Who. Led Zepplin was our opening act. We did Ed Sullivan show twice. We were ROCKIN. But we made a huge mistake. It was our second album. IT SUCKED. Why, because it wasn’t music. It was a concept album not created by us the BAND. It was created by the late great Arhmet Ertegun, the head of Atlantic records our label and our producer Shadow Morton. This should have been their album. All we had to do was the same as we did on our first big selling album. Do great arrangements of current songs. We had 4-5 in the can already. But we didn’t, we listened to Arhmet and Shadow and actually ruined our career. This album bombed so bad that we had to run into the studio and record our 3rd album really fast to try and save the band’s popularity.

In the end the band lost so much ground trying to recover from this album that it eventually broke up. What was on this album titled THE BEAT GOES ON. It had voices in time telling you all these political views, crowds chanting, Seg Hiel (to Hitler) and Black power, back and forth in stereo, at each other, Winston Churchill talking, Edison on his first telephone and there was hardly any music. If I had to do it all over I would have NEVER release this record. It Sucked!

Other things I would have done was wear ear plugs in my ears from the days of big amps. At one time I was playing in competition with five dual showman bass cabinets with two 15” speakers in each total 10 –15” speakers for bass with three 200 watt amps, 2 stacks of Marshall amps and 2- 200 watt amp tops for guitar, and an organ with 600 watt Leslie speakers, and me pounding my butt off with my maple oversized drums with two 26” bass drums and a 6 in. snare. I hit with the butt ends of my sticks to increase drum volume because there were NOT any PA systems in 1968. So I had to pound hard.

By 1973 with the Beck, Bogert and Appice group, we did have PAs and monitor systems and I had a monitor that was deafening. My ears use to ring after each gig. Luckily, I do not have permanent ringing in my ears like my partners Jeff Beck and Tim Bogert. I just lost lots of top end in my hearing. I didn’t notice it was happening, if I couldn’t hear the TV I turned it up. Not until I had kids and started living a normal life at home did I realize how bad my hearing was. In 1992 I went to get my hearing tested and fitted for musician ear- plugs. The people there told me I was a candidate for hearing aids. I said yeah OK!!! But I did start wearing earplugs. Musician plugs, which do a great job except when you’re pounding your butt off, and my drums sounded very small to me. I then started taking them out to do a drum solo. I needed to be able to hear the power of my kit coming from the stage. Then I would put them back in. Eventually I started wearing only one plug in one ear. After a while I started having to listen to TV with earphones. Even in the recording studio, my hearing started to suffer. I had to wear plugs in my ears and then the earphones. The studio earphones had so much top end that I could not hear anything else. Wearing the earplugs helped. This went on for years, I started to not be able to follow conversations at a dinner table. Then my new girlfriend Leslie insisted that I go for a hearing test and try to get some help. My sister recommended a guy near her work that would check my hearing and try out a hearing aid. Buy this time I couldn’t hear movies correctly in a theater and it was getting bad, so I went tried out the hearing aids and BAM I could hear much better. If I only would have worn ear plugs earlier in my career I would not have lost so much of my hearing. But I have it back when I wear these hearing aids. And the funny thing is that many of my drummer friends have the same hearing loss from playing drums. So my expression I use at clinics is: “WHERE EAR CONDOMS, SO YOU DON’T GET HEARING AIDS. “How true that is!

Well these were some things I would have done differently if I knew then what I know now and I’m sure I would have been better off.
Keep rockin Carmine Appice.

Doane Perry was born on June 16,1954 in Mt. Kisco, New York later attending Browning, St. Bernards and Collegiate Schools tghen New York University for 1 year and extension programs at The New School, Rutgers, and Julliard.

Doane began playing piano at age 7 and by age 11 when the Beatles came along I took up the drums. By age18 Doane turned professional and began doing everything he could to gain a wider musical background. Doane has been the long time drummer for Jethro Tull.

Over the years Doane has worked with a wide variety of gifted artists and bands including Lou Reed, Bette Midler,Todd Rundgren, Pat Benatar, Martha and the Vandellas, Peter Cetera, Dweezil Zappa, Laura Branigan, Dionne Warwick, Liza Minelli, and Stan Getz to name a few.

Doane Perry: In recent years I have noticed a marked and sharp change in my body’s willingness to cooperate as it once did so naturally when I sit down to play the drums. Years of very strenuous, physical playing, in the studio and on the road have suddenly come to collect the long overdue bill.

When I think of it in terms of the arc of the average professional athlete’s career, I consider myself and those of my musical colleagues of a similar vintage, extraordinarily fortunate. You won’t find many professional athletes who are engaged in seriously strenuous sports still able to function professionally into their 40’s or 50’s without some playing related injuries or chronic physical problems. Musicians generally have a much longer professional career that they enjoy but we all face different playing injuries that are simply a result of the repetitive nature of our work, our personal physiology and the idiosyncrasies of our particular instrument and set up. Drummers in particular can have more of a range of physical difficulties due to all the variables that exist based on the way we sit and the positioning of our equipment.

However, knowing what I do now and looking back at how I arrived here, there are a number of things that I would have done differently and certainly paid more attention to in the early stages.

From my early 20’s onward, I always played with my larger crash cymbals fairly high. Having seen a number of great drummers who placed their crashes high, I thought that it created a dramatic visual effect, without giving any thought as to what the actual physical consequences and repercussions might be! While that was fine then because I was younger, stronger and more resilient, my slightly less resilient, battle scarred body now takes exception to this practice.

Tendonitis and arthritis can also be an unfortunate by-product and a common occupational hazard amongst many drummers regardless of cymbal height. However, if this is recognized and dealt with in its early stages, many more serious long-term problems can be avoided. Both of these conditions I have dealt with reasonably effectively for a number of years through a combination of physical therapy and certain nutritional supplements. Unfortunately they were a precursor to a much larger problem despite the steps I took to deal with the early symptoms.

Consequently, I have recently been diagnosed with having a substantial tear in the rotator cuff of my right shoulder and a partial one in my left. This is something any musician really wants to avoid at all costs, as it is an extremely painful condition and one, which is not always simply treated. As a result, I have dropped my larger crash cymbal heights down considerably. They now sit slightly below shoulder height and could probably go even lower, but I am trying to gradually adjust things so that there still remains a familiar “comfort zone” in terms of the way I orchestrate my parts, but within a more contained area. I have also experimented from time to time with removing my third rack tom and placing the ride cymbal there, low down and almost directly in front of my right hand. Although it means having to change certain linear patterns on the toms due to the geographical jump, it has also opened up certain other patterns that would have been impossible before. For many years my set up remained very similar but my recent physical challenges necessitated a rearrangement of my gear and I am glad for that, as it has in turn, opened up new ways of playing that I might not have considered before.

Another very critical area that is often overlooked when one is younger relates to hearing protection. I cannot emphasize this enough. We have all read about the terrible effects of tinnitus and related hearing loss but often until one experience it first hand, can you really understand the gravity and long-term implications of such a condition. I have been in situations where I have been required to play very softly counterbalanced by other situations where I have been required to play very loudly. Drums, by their nature, can often times be quite loud instruments. Cymbals in particular, weigh in on the more seriously damaging side of things as well as repetitive, loud rim shots on the snare drum. For many years while I was in my 20’s, I never wore hearing protection, even in the loudest situations and I regret that now. I simply got accustomed to the ringing in my ears that would follow playing loud concerts or even having my headphones set too loud for extended periods in the studio. I started with simply wearing earplugs because I became concerned about the ringing in my ears, which was lasting longer and longer and getting louder and louder. And I was getting a lot of headaches, admittedly self-induced!

When in-ear monitors first began to be introduced I immediately tried them and it didn’t take long to adjust to this more effective way of not only blocking out harmful frequencies but also hearing the other musicians clearly at more sane audio levels. Additionally, this eliminated the post-gig ear ringing and it also substantially improved my touch on stage. It allowed me to hear all the elements of my drum kit with much greater articulation, with the hi-hat and cymbals being particularly enhanced by this new method. I was able to hear my hi-hat and ride cymbal with much greater clarity and as a result I could play them with a wider dynamic range and actually hear everything. What a revelation!

Looking back with the wonderful benefit of 20/20 hindsight, I also have recognized my highly “workaholic” habits of behavior. While this has served me very well up to a point, giving me incentive to practice, study and gig constantly, it also has a down side. I was quite happy working 16 hour days, doing sessions and live gigs, for literally months on end, with hardly a day off. I am not complaining at all as it my choice entirely to take on so much and I feel that it helped me enormously while serving my “apprenticeship” in the music business. It was what I believe I needed to do to get somewhere. It helped me to develop focus, drive and discipline and I’m sure many other professionals, whether they are doctors, lawyers, athletes or artists have felt it necessary to put in those hours at some point, in order to get where they wanted to go.

My difficulty is that I didn’t learn when or how to stop or even curtail some of that behavior. Even after I joined Jethro Tull I enjoyed the challenge of doing all of these other outside projects when the band wasn’t working… And we worked a hell of lot to start with. And despite the fact that they were all musical projects I really wanted to be a part of, it still added up to a LOT of work and not enough time off. I think I have finally learned the value of pacing myself and having time to reflect.

Enjoying time with my wife and family or simply sitting alone in the garden, contemplating or reading is highly valuable, rewarding and restorative time and I wished I had discovered the value of this practice long ago. In part, this was a very hard won lesson, as I just kept working and working, despite overwhelming fatigue at times. My body finally rebelled and started really letting me down in the last few years, which resulted in several different surgeries, including ones on my feet, back and this current condition in my shoulder. Some of those have been a result of genetic inheritance and some directly as a result of the work that I do. Nonetheless, I have come to believe that because “I” wouldn’t stop, my body finally stopped me instead and said, “ENOUGH!” I finally got the point and now I am really trying to achieve a meaningful balance between work and the rest of my life. So, if I can offer any personal advice from the perspective of age 53, it would be, slow down a bit, pace yourself, enjoy the scenery and all of the life around you, your family, your friends and not just your work or your time off. Take time to reflect and don’t worry about what anyone else is doing. It all goes by pretty quickly and I think each one of us would like to reach that inevitable end point and be able to look back and feel we have led a life well lived and loved.

Myron Grumbacher is a charter member of the Woodland Hills Drum Club with his long time friends Gregg Bissonette, and Doane Perry. Myron is best know for his work playing drums for Rick Derringer, Bob Dylan, Lita Ford and Pat Benatar.

Myron Grombacher: So my good friend and fellow drummer and physician in residence to the Woodland Hills Drum Club calls me and Says, I’m writing an article dealing with a drummers life-style and I want to know if there is anything you would have done differently if you had the chance. What? I said. Is there any thing you would change about, What, I said? In fact I say what a lot because of hearing loss. Why, because I never, ever wore any hearing protection. In fact I loved it loud! Loved it! In the good old arena rock days too much was not enough. You would start rehearsal with just a floor wedge, then another, and then maybe an S4 column, then another and another. Soon you’ve got you’re own mega watt sonic reducing temple of pure noise. Not that I needed it, I was hitting the drums so hard the heads barely lasted the night. The floor toms would leave the ground from sheer trauma. Houston we have lift off!
Patti (Benatar) used to call it death by snare drum. And my brother in noise Neil (Giraldo) and I would put a Marshall stack just to the right of the drum monolith. Fortunately, Jeff Chonis my trusty side kick wore the same dead phones favored by airline ground crews and I believe has fared a bit better than I. And click tracks, I won’t even go there. Now a day, we have inner ear monitors and headphones that limit outside noise, so you can slam and jam and not have to be a click cranker! So the life lesson from me to you is always protect your hearing. The damage is pretty much irreversible and some day you may want to listen to something soft and beautiful. Finally, I would limit swinging from the gong stand. Every time it’s cold and rainy, I revisit Madison Square Garden and the Kelsy Seebolt clinic in Dallas Texas. Like St. Anthony’s said “THEY SOUND BETTER WHEN I HIT THEM HARD “, but never ever without protection.

Dave Weckl has developed and maintained a reputation among fans, peers, and the international music community as one of the greatest living drummers. For this, he has received numerous accolades and honors; Modern Drummer inducted Dave into their Hall of Fame and named him “one of the 25 best drummers of all time.”

Born in St. Louis Missouri, January 8, 1960, Dave started playing drums around the age of 8.

At age 16, Dave began to work professionally with local pop and jazz groups. In 1979, he moved to the East coast to study music at the University of Bridgeport in Connecticut. At just 19 years of age, Dave was getting recognized. Dave has played on the prestigious Simon and Garfunkel reunion tour in 1983 an on numerous radio and TV jingles, sound track sessions, and top recording dates with such artists as George Benson, Peabo Bryson, Diana Ross, and Robert Plant. Dave has played with Chick Corea prior to becoming a solo artist. Dave has recorded and produced nine recordings to date.

A constant student of the art of drumming and music, Dave gives back every chance he gets through clinics and classes all over the world.

Dave Weckl: I am blessed and thankful to be able to say I have been playing drums for more than 40 years now. I don’t plan on stopping any time soon because the quest to always find a new path; something different to play and learning about new and different music from far away places, are life-long desires.

Unfortunately, finding the time to keep doing it and having the body cooperate without protest to the endless hours it takes to satisfy the quest is a challenge. In fact, there are many physical and emotional hurdles to overcome along the way.

I will try to shed some light on the hurdles I have faced and what I might change looking back at 40 years of playing. First, I’ll start with things that I would not change. These things emanate from my family and social standpoint, and have helped shape who I am.

I am an only child, and my parents gave me the foundation and freedom to choose my path. I still thank them every day for this. They gave me guidance and helped me in so many ways.

Of course, it was still up to me to make the choice that playing the drums was to be more than a hobby – much more. But the guidance they gave and my own belief in drumming and music shaped my decision to pursue it as a career. I would never change this – the belief in what I wanted and the belief in myself.

Being a kid though, other things eventually entered into my ‘time space’ arena. I loved sports, and played a lot of them between the ages of 6 – 13;mostly baseball, soccer, and football. This is where some distractions and physical hurdles came into play.

It was that one-year of football, and probably soccer over the other six years, that messed up my knee. My dad tried to talk me out of the football thing; I was too small, and he knew it, but peer pressure kicked in. I was 13 and girls were starting to be important! I wanted to be a jock and get some attention from the cheerleaders!

If I could go back and make that choice again, I definitely would not have played football. My right knee, although not needing immediate attention then, became a real problem in my late 20s. It inhibited me from playing the foot pedal the way I wanted to, and this condition eventually became quite painful.

I ended up having knee surgery in the early ’90s and, although it got better, my knee really never came back 100%. This was probably due in large part to the continued stress of playing drums (and still wanting to be a part time jock!).

One thing I have definitely learned regarding drums and knees: your pedal and bass drum muffling/tuning practices can definitely affect how much shock your body absorbs. The more dead your bass drum is from padding and/or thicker heads, the more shock to the body.

Over the past 10 years, I have tried to muffle my bass drums a lot less, and even helped design a muffling system with Remo to aid in the effort. The idea was to let the head ‘give’ a bit, allowing the drum be more responsive and less shocking to my body.

A thinner head helps, too. The best scenario is to play a double headed drum, and get the beater out of the head (the latter also being important from a musical standpoint). Then, the drum can respond like the rest of the drums on the kit.

Some pedals are very stiff feeling too, not able to dissipate shock very well, so it goes up through your leg. Using straps instead of chains, and felt beaters, seems to help.

One good decision I made after that fateful year of football was that drums would be my focus. I dropped out of all organized sports that next year, diving into heavy practice, no longer letting peer pressure determine how and where I spent my time.

I was in junior high now, and had just gotten into the high school jazz band. The inspiration (and necessity!) to get better was very strong. Again, this is something I would not have changed: the strength and determination to follow my own path.

But this does bring up another aspect of being a hard-working and focused person: you don’t have to lose you social skills! For me, it simply has meant picking friends wisely, and hanging out with whom I WANT to, not because I feel I HAVE to.

This also brings up other aspects of coming-of-age as a person and especially a musician.

Drugs and alcohol can be a temptation for anyone growing up, especially those who hang in musical circles. But getting into these things did not fit with the goals I was chasing as a musician or a person, so I never altered my course in that regard. I had no interest in polluting my body and making life harder than it already was!

I was stressed a bit about this early on in my career because I knew the stereotype of some people in the profession. Thankfully, by the time I got to New York in 1979, the industry was changing.

It was no longer cool to be high, at least not in the circles I wanted to get into, which was the studio/live scene in New York City. I was very happy to discover that my playing and my character could help me gain the respect I needed to succeed.

Again – the same lesson: stay strong.

As I got a bit older, having moved to the East coast, I started to climb the ladder of progress and success. The hours of practice and ‘use’ of the body too not only play the drums, but also to MOVE them too, got more intense. This is when more of the physical aspects of the job began to take their toll, particularly on my hands, arms, shoulders, and neck.

These are problems any drummer can face – and I have become a bit of a spokesman for these conditions over the years.

Let’s put it this way: anytime you hold your body in an “unnatural” position for long periods of time, you are asking for trouble, and pain! This can cause an endless domino effect.

For example, I used to play my main ride cymbal pretty high to the right of the second rack tom on the bass drum. This positioning was necessary to attain the clearance necessary to hit the rack tom cleanly, and still be able to get to the ride.

The problem is that it caused me to have my arm up in the air, thus crunching my shoulder against my neck. This caused nerves to eventually get pinched, causing numbness in the fingertips and hands – eventually leading to my hands freezing up.

When adding the stress of carrying lots of boxes and equipment, things got bad, leading to a catastrophic event while playing live in South America. I was playing a show with my newly-formed group, and after a very successful first set, we came back out to play a “labor intensive” song. I was “stretching out” to play all the parts, some of which requiring me to focus on percussion to my left. I got through most of the song fine, but during the drum solo, my hands just froze!

It wasn’t an unfamiliar feeling, but it had always been the right hand that would go, and that only happened a few times in the 25-30 years I had been playing. It was usually a temporary condition, but not this time. BOTH hands froze, and I could not hold a stick! For the first time in my career, I had to stop the show, get up, and announce to the crowd, “sorry, I need to take a break here!”

I really had no idea of what to do! Ice? Heat? I was in South America on top of it, so English-speaking people were not all that accessible! It was very frightening to say the least.

I ran hot water over my hands to try and get blood flowing while also stretching them out. I went back out 25 minutes later and somehow finished the show, walking on eggshells the whole time.

I was eventually told that this was due to ‘repetitive motion’, and later, the 5th vertebrae hitting nerves due to being out of place. I was also told this was caused by being in the wrong position for too long, including when I slept, but especially when I played the drums.

I went to Gordon Chiropractic where Arlo Gordon and team (yeah Arlo and Dr Mike!) “fixed” me, with nutrients, adjustments, and advise. I bought a pillow that keeps my spine straight no matter how I sleep, and I set up my gear so as not to reach unnaturally.

I also stopped playing matched-grip almost altogether, as I was switching back and forth quite a bit in those days, causing muscle tension. I am now relying on my old tried-and-true traditional grip. The neck/hand problem has not returned now in more than seven years, thankfully.

The lesson in all of this- As you get older, pay attention to how you sleep and your pillow choice. Try and keep your neck straight.

On the kit: set things up to reach everything without moving your body too much in any direction. Don’t LIFT a lot of heavy things, especially with your fingers! Figure out how to get someone else to do that! Barter if you have to! Offer a free lesson in exchange for carrying your stuff! And hire movers!

Of course, you never know what is going to catch up with you down-the-road. A few years ago, from playing traditional grip and still reaching a lot for that percussion (and probably from doing a chest fly on a Bowflex machine), I started to develop a shoulder problem in my left side. MRIs revealed a small tear in my rotator cuff.

Many drummers have had this problem, and after calling around, the author of this article, Luga Podesta, was referred by many. He sent me to a physical therapy practice called ‘Athletic PT’ in Thousand Oaks, CA, where the staff (Eric Honbo was in charge of me most of the time) really knew their stuff.

Through small, lightweight but intense exercises, they helped rebuild a lot of the smaller muscles around my shoulder tear and the biceps tendon that was out of whack, too. Once again, I seemed to have beaten the odds, and had managed to continue playing fairly uninhibited.

What I learned? Don’t reach so much back and behind you when at the kit. Again: setup is important to stay in a more natural flow with the body. And – be careful with weight-bearing exercises that can cause injuries!

My biggest problem now is an arthritic thumb in my left hand. I believe this condition, though partially due to heredity, is also due to playing the traditional grip far back in my hand for so long while slamming backbeats. This is something I don’t do now, and haven’t done for many years, but know has caused a lot of stress on my thumb for many years.

My point in mentioning it is to think about your positioning, both how you hold the sticks, and how you hit the drums. Since I was going back and forth so much from traditional to matched grip, the kit was set up to try to accommodate both – a fairly impossible task in terms of heights and angles.

In my latest video series, ‘A Natural Evolution’, I go into great detail about approaching the kit from a natural standpoint, and setting up that way as well. Get the sticks to work for you, to bounce, so you don’t have to work so hard to play. Most of this approach is the result of what I have learned from my most recent teacher, Mr. Freddy Gruber.

These physical conditions, which many drummers go through, are all works-in-progress for me. The best you can do is try to prevent bad things from happening, but also learn how to cope with the inevitable issues that come up.

The same can be said for the personal stresses that working musicians often face.

At the end of the day, achieving excellence in music or any career means making some choices. Particularly in music, where rehearsal time and travel take a toll, it is important to be honest with yourself and the people in your life about the realities of the business.

An aspiring musician needs to have undistracted time to focus on the craft while also having time to perform music as part of a career. Life has many distractions, but a relationship needs to be built around an understanding of these needs, or trouble can arise, causing more distractions, and inhibiting creativity and growth.

Undoubtedly, our physical and emotional lives are intertwined. The moral of the story: there will be plenty of physical and emotional hurdles to overcome in our lives. There a plenty of things we all can look back upon and want to change.

For me, learning how to make wise choices in my personal and professional lives is an ongoing area of growth. But at the end of the day, I can honestly say that the things I would keep the same far outweigh the things I would change.

That inner-strength and my parents’ guidance led me on a path I know I was meant to follow. Clearly, this is the most important part of the equation.

Jason Bittner, a native of Albany, NY, started taking formal drum lessons at the age of ten years old, however he had been banging on pots, pans, and garbage cans since he was about five. He continued to take lessons and perform before heading off to the prestigious Berklee College of Music in 1988.

Jason left school to begin playing in various metal and hard rock bands throughout the late eighties and early nineties

In 1994 he joined Stigmata, who was, at the time, one of the biggest hardcore bands on the New York scene. Over the course of the next 7 years, he recorded 3 albums, released a home video, and toured the U.S. and Europe.

In the fall of 2001 Jason joined Century Media recording artists Shadows Fall for whom he continues to play with today. Bittner has received numerous accolades including his first Modern Drummer Reader’s poll for #1 Up and Coming Drummer of 2004, the 2005 Modern Drummer readers’ poll #1 Best Recorded Performance, and #1 Metal drummer in 2005 and 2006.

Janson Bittner: From a medical standpoint I have had a chronic arm/shoulder/neck issue for years that started with the arm, and then other areas started to become affected due to the weak arm. The first thing I would have done differently was LISTEN to the Doctor, who told me to take 3-4 weeks off, rest the arm, and not play in 3 different bands. Unfortunately I was young (26), naive, and I thought I was invincible. Well long story short, I made the issue worse, and have had to deal with it for years. Injuries are no fun on the road (not to mention the hundreds of dollars I spend for massage therapy while on the road). Fortunately I’ve had the good fortune to work with Dr. Podesta over the last year, and I’m happy to say that I’m feeling much better now concerning that problem. My arm isn’t 100% and it may never be (due to my past stubbornness) but it’s way better than it was! From a lifestyle standpoint, I would have listened to my mother who always told me I was doing to much to my body A typical day used to be 2-3 hours of intense drumming, followed by a 2 mile run, and then a trip to the gym later for a work out. I’ve realized many, many years later that the 2-3 hours of drumming was enough for one day! Besides, I didn’t have the genetics to be a bodybuilder! From a social standpoint knowing what I know now, I would have never taken back any ex-girlfriend who cheated on me once, because if they did it once, they’ll do it again!

For me I will stick with medicine and continue to take care of my newfound friends aches and pains and continue to improve my skills as a drummer. As most of these legends are around my age, I can only commiserate with what they have been through and what they are feeling. There are many lessons that can be learned from these experienced individuals words. You don’t have to make the same mistakes as we have. We continue to learn throughout are lives in many ways, through experiencing life, through failing, after succeeding and from listening to and observing others accomplishments and mistakes. Take these individuals life experiences and learn from them. Don’t allow yourself later in life wonder “If I Only Knew Then What I Know Now!” By then I may be too late.

It’s Not Always Carpal Tunnel !

Pain, numbness and weakness in a drummer’s hand or wrist can arise from many different sources. These complaints are most commonly due to carpal tunnel syndrome (DRUM ? issue). However, not all symptoms in the hand are due to this common nerve compression at the wrist.

The ulnar nerve is another nerve that can affect the hand and wrist. It originates in the spinal neck and passes through the arm, forearm and wrist into the hand. Due to its superficial position at the elbow, it is often injured by excessive pressure either by leaning on the inside part of the elbow or by repetitive bending and straightening of the elbow. A second common area of compression of the ulnar nerve is in the wrist as it passes though a tunnel on the pinky side of the wrist called Guyon’s Canal. Injury can be due to direct repetitive pressure overt he palm of the hand (hand percussion) or after a fracture of the wrist. Whether an injury of the ulnar nerve occurs at the elbow or wrist, the end results can severely affect hand function and be devastating or worse career ending to a drummer.

The ulnar nerve functions to provide sensation to the pinky finger and half (pinky side) of the ring finger. It controls most of the small or intrinsic muscles in the hand that provide fine movements in addition to some of the larger forearm muscles that provide a strong grip.
Symptoms of ulnar nerve entrapment or compression frequently begin with a sensation of the hand ring finger and pinky finger ” falling asleep “, which worsens when the elbow and or wrist are bent. Carpal tunnel syndrome has similar symptoms, but involves a different nerve and typically causes numbness and tingling in the thumb, index finger, and middle fingers. Numbness and tingling in the ring finger and pinky finger are common symptoms of ulnar nerve injury. These symptoms can come and go and can occur more often when the elbow is bent. Numbness and tingling in the hand will frequently awaken people sleeping with their elbows bent at night. Aching pain often develops on the inside of the elbow or on the pinky side of the wrist. With a longer standing compression, it may become difficult moving the fingers or manipulating objects. Weakening of the grip and difficulty with finger coordination can occur with more advanced or prolonged ulnar nerve compression. Permanent injury to the hand muscles causing muscle wasting or atrophy is the end result of severe or prolonged compression.

The diagnosis of ulnar nerve compression is suspected when a number of clinical findings are found by your physician such as a positive Tinel’s sign, an electrical shock sensation over the inside part the elbow (funny bone area) or over the pinky side of the wrist, numbness and tingling in the pinky side of the ring finger or in the pinky finger with wrist or elbow flexion. However, the definitive diagnosis is made by performing a nerve conduction/electromyography test (NCV/EMG), which is an electrical test to evaluate, nerve and muscle function

Treatment of ulnar nerve injuries begins with identification and elimination of the cause of the injury. Anti-inflammatory medicine can help reduce swelling around the nerve. Therapy with exercises to help the nerve slide through the tunnels can also help to improve symptoms. Bracing to prevent the elbow from bending at night (night extension splints) and elbow pad worn during the day to minimize direct pressure on the nerve has also been helpful diminishing symptoms. In severe cases however, surgical treatment to relieve compression from the nerve around the elbow and or wrist is necessary.

Drummers are not immune to nerve injuries. It is imperative that we take proper precautions such as warming up and cooling down before and after playing, avoid leaning on the elbow as well as maintaining an ergonomic set-up of our drum kits limiting excessive degrees of elbow flexion for prolonged periods of time. An ounce of prevention is worth a pound of cure.

Knee Pain-When is it time to seek help?

Knee pain is a common complaint among drummers. There are a number of conditions that occur commonly in the knee as the result of excessive activity or a singular traumatic event such as a twist. Many of these conditions will result in knee pain. We need to be able to differentiate which need immediate medical attention and which conditions need medical evaluations.

Basic Knee Anatomy

The knee joint in made up of 4 bones: the femur or thighbone, the tibia or shinbone, the patella or kneecap and the fibula. The bones are held together by 4 ligaments: the anterior cruciate ligament(ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL). These ligaments provide the major stability for the knee.

kneeThere are also two types of “cartilage” within the knee, the meniscus and articular cartilage. Both structures provide stability and an almost friction free surface for the knee to bend.

Finally, the knee is supported by a number of muscle tendons that attach to the bone of the knee to provide movement.

All of these structures can become injured due to a singular traumatic injury or from overuse.

Knee Injuries

The most common injuries that occur with drumming involve either the patellofemoral joint (knee cap).

The majority of the injuries that occur in the knee can be differentiated from one another by where the knee is painful and or swollen.

Knee Cap Pain

Kneecap or patellofemoral pain is the most common knee complaint. The majority of times it is due to the kneecap moving abnormally within the groove of the femur or thighbone. The kneecap can sometimes “track” abnormally or actually jump out of its groove and subluxate or dislocate. If severe enough, this may require a physician to place the kneecap back in its track.


Patella Subluxation

Patella Subluxation

Patients will usually complain of pain localized around the kneecap. Swelling in usually not a complaint. Pain occurs with sitting, getting out of a chain or climbing or descending stairs. None of these conditions are orthopaedic emergencies, but should be evaluated by a physician if the persist.

If a knee injury occurs and you have experienced: a pop, pain, immediate swelling, giving way or buckling, locking, bruising or gross knee deformity seek medical attention.

Next months article will discuss the treatment and prevention of knee injuries in drummers.

About Dr. Podesta

Dr. Luga Podesta is a nationally recognized sports medicine physician specializing in the non-surgical treatment of orthopedic, musculoskeletal and sports related injuries to the shoulder, elbow, knee and spine.
Dr. Podesta has practiced non-surgical orthopedics and sports medicine since 1990. Dr. Podesta is a diplomat of the American Academy of Physical Medicine and Rehabilitation and is Board Certified in both Sports Medicine and Physical Medicine and Rehabilitation.

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