N. has been working in the orchestra for six months with a 100% position. She is currently practising and rehearsing difficult orchestral pieces and complains of pain in her shoulders and neck. In the first lesson, I discuss with her the connection between situations, thoughts and physical sensations.

To get to the bottom of these connections, you need a fine, free, sensual attention. I give N. an observation sheet. In the next lesson she says: "When I was hurrying with the cello on my back, I felt hectic, breathless and tense in my back and neck. Becoming mindful while doing this had a pleasant and calming effect".

In the third lesson, N. is a little sad because she realizes "how I keep tensing up". I recommend that she reads the chapter about his own story in F. M. Alexander's book The Use of the Self. In it, he describes the development and methodology of his technique. After reading it, N. will be amused by the human stubbornness to insist on ingrained patterns.

I instruct her to lie down on the table. She relaxes as I guide her with my hands and words, which she finds very soothing. After about twenty minutes, she should sit up, be mindful during the movements and avoid unnecessary tension, especially in the neck muscles. In order to perceive inappropriate tension, it is advantageous to perform movements slowly at first. Over time, the quality of movement can also be assessed at a faster pace. N. rolls onto his side, pushes his legs over the edge of the table and sits up.

Her sitting on the table is now very upright and relaxed at the same time. She finds raising her arms light-hearted and playful. As I instruct her to play a short musical sequence "in the air" without a bow, she tenses her neck a little, collapses slightly on the right side of her chest and raises her right shoulder to compensate. Only when I ask her how her right side and neck respond to the raising of her arm does she realize it. She also notices that her arm is no longer quite as free as before. Using my hands and words, I work with her not to fixate on the goal of "making music" when raising her arm, but to strive for the goal and at the same time pay attention to the means of achieving it.

In the fourth lesson, I work with N. sitting down and on the instrument. She complains that she still does not have confident control of the bow arm and that her sound is impaired as a result.

A favorable approach to the organism as a whole means a good balance of tension and relaxation and working with the appropriate amount of energy for the situation. Making music requires muscle tension in the right place, at the right time, for the right duration and in the right dosage. N's pelvis is tilted backwards on the chair. I don't work with her directly on the bow arm, but my aim is to bring her head, neck, torso and legs into better balance.

When she is looking for "good posture", she soon feels a familiar pain in her lower back. I let her experience how she can balance on the sitting bones as if on runners. For this to be possible, she needs freedom in her hip joints. I ask N about their exact location. In her imagination, the hip joints are much higher than in reality. She looks at my little plastic skeleton and is amazed at how flexible her pelvis is and how her feet make better contact with the ground when she adapts her body image to reality.

This straightening of the pelvis results in a higher tone in the lower abdomen, while the shoulders and neck muscles relax at the same time. N's right arm now feels flexible, relieved and alive in my hands. "It's like my body is thawing out," she says.

In the fifth lesson, N is pleased that she has repeatedly succeeded in using and integrating the experiences gained in our lessons. She feels more energy and joy and occasionally a new sense of oneness with the instrument. After a work-related break, we will deepen our work in two months' time. In addition to handling the instrument, we will then work on various everyday movements as well as with the breath and the eyes.

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The functional circle of problems that can lead to occupational disability

The extremely high physical and mental demands of the music profession have reached a level that can go far beyond that of a top athlete. The perfectionism of "clinically clean" CD recordings, which has often become the measure of all things today, leaves little room for individual idiosyncrasies. Recordings in the recording studio are polished up with the help of editing techniques and post-processing so that they create the illusion of perfection that no performer is able to achieve in real performance. This ideal of reproduction has become a great burden. Individual performance can be scrutinized and puts performers at a disadvantage. Added to this is the fact that the competitive pressure to fill musical positions has steadily increased in recent decades. The pressure can leave internal traces that are not immediately visible to the outside world. They usually manifest themselves indirectly in moods, dissatisfaction and ultimately despair, which those affected experience themselves as "having to bite through".
Tension and cramps ultimately manifest themselves in psychosomatic diseases of the organs, functional disorders of the musculoskeletal system and malfunctions of the masticatory system. Psychologically induced malpositions of the body are also stabilized by teeth grinding and clenching and vice versa.

The importance of the masticatory system

 The masticatory system plays a central role in the path to occupational disability: Non-blowers compensate and stabilize themselves via the occlusion. Blowers who cannot stabilize the mouthpiece via the rows of teeth shift the tension directly into the motor organ. How does the specialist recognize the involvement of the masticatory system in the many psychological symptoms? It helps to look at the patient's medical history (anamnesis). What stresses, worries, hardships and helpless therapies have those affected already undergone? Which symptoms occur when? The dentist also analyzes the functions of the masticatory system clinically and with analyses using dental models in the masticatory computer (articulator). An interdisciplinary orthopaedic specialist will prepare a functional assessment of the musculoskeletal system. A physiotherapist or psychotherapist can also be helpful in some cases.
We discuss the results on an interdisciplinary basis. This results in a targeted treatment plan. This can include: mental training techniques, physiotherapy, postural corrections without and with instruments ("no overloading without incorrect loading"), bite compensation using selectively constructed occlusal splints to relax the masticatory and musculoskeletal system, harmonization of the bite by removing incorrect contacts or dental reconstruction measures for malocclusions and/or missing teeth (dentures, veneers, implants, crowns).

Accidents require special measures

Accidents - soft tissue injuries to lips and cheeks or tooth fractures and tooth loss due to external influences - can suddenly lead to occupational disability. They require a cautious approach. The physiological changes can be accompanied by psychological impairments. This applies to whiplash injuries, for example. The fateful blow to the neck causes pain and poor posture due to permanent psychological pressure. Those affected feel "a fist in their neck", adopt a forced posture and their intervertebral discs wear out. Permanent pain and occupational disability follow.
Musicians of all ages can be affected. We have developed our own programs for prevention - based on a musician study we conducted between 2001 and 2004 at the Bern University of the Arts on woodwind players: orthopaedic posture and movement analyses were carried out with and without the instrument in a sitting and standing position, as well as functional analyses of the masticatory organ. Treatment was required for around half of the musicians. This experience flows directly into our dental diagnostics and treatment.

Dr. med. dent. J. E. Lahme
Specialist for musician treatments
Schulgasse 18
A-6850 Dornbirn
Tel. 0043 5572 386 333 Fax DW -8
lahme@aon.at
www.zahnart.at