This post was originally posted in the British Horn Society magazine
In this article I want to talk about Arthritis, a medical condition I’m sure you’ve all heard about, and what impact it may have on horn playing.
But what is it? Is it inevitable with age? Are we all going to develop arthritis as we get older? Does a diagnosis of arthritis mean stopping playing the horn?
Well, these are just some of the questions I’m often asked in clinical practice (and in the rehearsal room) which I hope to be able to answer here today. I’ll start by explaining what arthritis is and then what the options are if you have it.
Understanding Arthritis
Arthritis is a medical term that actually encompasses many different conditions affecting the joints. It is one of the most common chronic health problems worldwide and it can impact people of all ages. However, there are some kinds of arthritis that are more recognisable and prevalent than others.
‘Wear and tear’
We probably all know someone who has been told they have ‘wear and tear’ in a joint and assume it to mean they have arthritis, or Osteoarthritis (OA) as it’s clinically known. In fact, the two are quite different.
Wear and tear refers to a natural ageing process. Over time, with each decade that passes, our joints slowly degenerate. I know. Depressing, isn’t it? The protective cartilage lining the bone becomes thinner, there is less fluid circulating to lubricate the joints and, in the case of the spine, the discs that sit between each vertebrae dehydrate and thin a little. This is all normal. If I were to Xray a dozen joints all over the age of 40 it would be normal to see varying degrees of ‘wear and tear’. In the vast majority of cases it causes no problems at all and is often an incidental finding seen on Xray. If you’re of a certain age and have the occasional ache in a joint which goes away of its own accord, it’s likely to be natural ‘wear and tear’.
Osteoarthritis however is not normal wear and tear. It’s when the natural ageing process is over and above a joint of its age. Cartilage becomes so thin it can expose the bone underneath. Bone spurs (called osteophytes) can grow around or within the joints, and cysts can grow on the bones, all of which lead to pain, swelling and limited movement. It is a genetic, degenerative condition that isn’t necessarily associated with old age.
Of the joints in the hand, the thumb is a common joint for the first signs of arthritis to appear. It can start as a bit of an ache around the base of the thumb. The joint can swell sometimes and become more painful over time.
This can be awkward for horn players. If the left hand is affected then using the thumb valve can feel stiff or painful. If it’s the right hand then it can be uncomfortable resting the horn along the thumb.
If the shoulder is affected then holding the instrument can be painful, particularly in the left shoulder. Hip or knee OA can make it difficult getting on/off a stage or getting around in general.
Note: there are other forms of arthritis such as Rheumatoid Arthritis (RA) which is an autoimmune condition whereby the body’s immune system attacks the joints, causing painful inflammation and joint deformity. It affects much more than just the joints and requires specialist medical intervention. But for the purposes of this article, I would like to concentrate on the more common type of arthritis.
What are the symptoms of Osteoarthritis?
The symptoms of arthritis can vary from person to person and the kind of arthritis present, but some common symptoms include:
· Joint pain: persistent joint pain is a hallmark of arthritis. It can range from mild to severe and may be constant or intermittent. There may be pain free days and then days that are much more painful
· Joint swelling: inflamed joints may become swollen, tender, and warm to the touch
· Stiffness: arthritis can lead to joint stiffness, making it difficult to move the affected joints, particularly in the morning or after periods of inactivity
· Reduced range of motion: as arthritis progresses, joint function can be limited, affecting daily activities
· Fatigue: chronic pain and inflammation often lead to fatigue, impacting quality of life.
Causes and risk factors
The exact cause of arthritis depends on the type of arthritis in question. Some common risk factors of OA include:
· Age: Osteoarthritis is more common as we age, while autoimmune conditions like rheumatoid arthritis can develop at any age
· Genetics: A family history of arthritis can increase the risk of developing the condition
· Joint injuries: Past joint injuries can increase the likelihood of developing osteoarthritis later in life
· Lifestyle Factors: Factors like diet, obesity and physical activity can influence the risk of developing certain types of arthritis. For example, many retired professional musicians have mild OA in joints that have been used repeatedly over many years.
Management and Self Help
Managing OA effectively involves a combination of medical interventions and self-help.
Here are some common approaches to managing arthritis:
· Medications: Depending on the type of arthritis, medications like Ibuprofen, disease-modifying anti-rheumatic drugs (DMARDs), or painkillers may be prescribed to reduce pain and inflammation.
· Physical Therapy: Osteopathy can help patients improve joint function, strengthen muscles, and reduce pain by taking pressure off painful joints.
· Self Help: Maintaining a healthy weight and staying physically active can help manage symptoms and reduce the risk of progression. Arthritic joints respond really well to movement as it helps to stop joints seizing up
· Assistive Devices: A ducks foot can ease pressure when holding the horn. Having an adjustable finger hook is also a good idea as it can be moved as and when needed depending on levels of pain. A support stick attached to the horn that rests on the leg can also ease pressure on the hands or shoulders when playing. Hand/wrists supports also give aching joints a bit of a rest
· Checking your valves: If you have OA in your thumb then having a chat with one of our horn care experts about the alignment/position of the valve and if it can be changed could help
· Surgery: In severe cases or when other treatments are ineffective, surgical options like joint cleaning (arthroscopy), a partial or total joint replacement may be considered.
Self-help:
The good news is that, as mentioned above there are lots of ways of managing OA. It responds well to gentle exercise to keep the joints supple and keep the muscles flexible.
There are hundreds of exercise resources available online but if you want personalised care then do go to an Osteopath for assessment and a tailored treatment plan.
They should be able to offer advice as well as hands on treatment that slows down the rate of further degeneration and help you manage the condition quite successfully.
So there you have a description of arthritis and the options available. But, before I go, I think it’s also worth pointing out that our joints will stiffen up and ache from time to time. It doesn’t mean arthritis.
It is worth paying a bit of attention to lifestyle and fitness just to be sure you keep your joints nice and healthy and if you’re at all concerned then pop off to your GP or Osteopath for a check up.