I am writing about only one case of "writers cramp." I realize that every case may be quite different; however, it is my hope that what I describe might provide benefit to other sufferers of this little known illness or to the medical personnel who are searching for cures.

I began having problems with my right hand while studying for a doctorate at the University of Iowa. I was under a great deal of pressure to complete my D.M.A. in two years while also experiencing fatherhood for the first time. One night I had a dream of being on a rack. When I awoke, I found my body taut. I experienced numbness in my arms, especially my right, for three weeks. After the numbness wore off, I suffered pain in the right arm, usually while sleeping, for a number of months. I saw hand specialists, orthopedics, and neurologists, but everything appeared fairly normal in their eyes. The pain also finally faded, but I was left with a right middle finger that contracted every time I picked up the flute. I did eventually learn to accept this condition, changing my F#s to the middle finger so I did not need to pick it up for an e/f# movement, and continued to play with few additional problems.

Three years ago I slipped on a ball and into a cement wall. I was taken to an emergency room in the middle of the night, and the doctors stitching my head had a good laugh over the incident. The accident appeared to produce only a surface wound with no permanent damage. A few weeks after that accident I noticed that I was losing control of my left middle finger. Every time I picked up the flute the middle finger would stick straight up. Now I was in real trouble playing the flute. I also began to experience what I thought were ear aches while sleeping. I continued to play flute for about half a year, but the finger condition worsened until my hand completely knotted each time I attempted to play.

One of my students suggested that I see a chi-kung doctor who had cured her of a shoulder injury. Up until that time, I had continued to see physical therapists, western doctors, and acupuncturists about my right hand problem. No one had any answers. I knew my career was over if someone could not help me soon.

In my first meeting with the chi-kung doctor, Mr. Hwan-Chang Wang, he felt around my neck area for what he calls "soft bone." He was quite sure I had developed this material, and asked me to get an x-ray of my shoulders and neck area to confirm this. The therapy consisted of a combination of pressure and chi applied to various points which he felt were obstructing my flow of chi through the body. It is by far the most painful procedure to which I have ever been subjected.

The New Encyclopedia Britannica says that chi in chinese philosophy is "the ethereal substance of which everything is composed." My chi-kung teacher, Yang-Ming Lu, thinks of chi in terms of bio-energy. "Although nobody knows what the element of chi is, the practitioner can feel the bio-energy when it moves through the body on a revolving path."

I would not have continued past the first session had I not felt an immediate change in my body. At the worst point of my illness, I felt that my hand was no longer a part of my body. I could not play a note on the flute or write. After one session I felt that my hand regained some sense of belonging to the rest of me.

The sessions sometimes lasted 40 minutes and at other times 20 minutes or less. Initially I saw the doctor three times each week. As my condition improved the sessions were diminished from two to eventually one per week. After two years the therapy ended. The doctor told me it would still be a period of time before I regained all of my strength, but he felt chi was passing smoothly through the body and would not be a problem in the future. 

I no longer suffer from aches near the ears. (The aches were actually caused by the jaws.) I also am back to normal fingerings on the flute and can play most any work with a brace I had made for the left middle finger. In addition, I am back to playing the baroque flute. I had not been able to execute forked fingers since 1990. Everyday I continue to experience improvement, so I know it is only a matter of time before I will be free of any crutches.

Mr. Wang is a very soft spoken individual. He reluctantly consented to an interview with my wife and myself about half way through my therapy. He only speaks Taiwanese fluently, so my wife acted as an interpreter. The following is a summary of the most important aspects of his diagnosis and therapy.

Mr. Wang feels my illness arose from the constant turning of the head to the left to play the flute, and insufficient rest between playing sessions. The constant blockage of chi at the pressure points in the neck from the position of the head obstructed chi from passing smoothly to various areas of the body. That is why I felt numbness and eventually pain and weakness in my hands. Without chi passing smoothly through the pressure points eventually my circulation got slower and slower arising in the formation of the "soft bone" tissue. To solve the problem the doctor needed to open up the blocked passages. Though I can feel chi when I practice chi-kung and could also feel the therapy freeing my chi to flow freely, chi remains a challenge for me to explain. 

I have either sensed chi as electricity pulsating through my body or as a feeling of heat. Chi is definitely attached to the same chi which means breath, but it also has to do with circulation of the blood. Mr. Wang says that there must be a balance between chi and blood circulation in order for one to carry on physical activity properly. He says that weakness in a part of the body is caused by a lack of blood flow to balance the chi, and that pain is a result of a lack of sufficient chi to balance the blood circulation.

The most important advice he gave me to keep from a recurrence of "writers cramp" was to take sufficient rest between periods of playing and always warm down after playing sessions. If I practice for 45 minutes, then I should rest an hour and a half before playing again. After every session I perform stretching exercises for 5 minutes or more. We often think about warming up, but rarely do we think about concluding our sessions with exercise.

I still am uncertain as to whether my head injury had any bearing on my condition. Doctors I have consulted doubt there is any relationship. I do consider myself extremely fortunate to be able to play again, and hope that my rehabilitation may provide hope for others suffering from similar conditions. I am not trained in medicine. I can do no more than to describe my situation to others and hope there are readers out there who may be able to use this information for future investigations. I have been told that Mr. Wang has gained the respect of many people in the medical profession in Taiwan. He certainly has gained my respect and admiration.

The year 1997 marks the 10th anniversary of the introduction of Prozac. Domestic sales of this drug in 1996 were $1.73 billion. Why should this matter to flute players?
Prozac belongs to a new class of antidepressants called SSRI's (serotonin-specific re-uptake inhibitors). Other members of this class include zoloft(sertraline) and Paxil(praroxetine).
SSRI's have less intense and more easily tolerated side effects than tricyclic antidepressants, an older class of drugs, but they have side effects of their own.
Thus individuals taking these new antidepressants can experience dry mouth, difficulty focusing one's eyes, nausea, and gastrointestinal distress. These effects may be tolerable in a rower, but for small muscle Olympians such as musicians, they can cause serious interference with playing.
Less well recognized is that abrupt cessation of antidepressants can lead to a withdrawal syndrome characterized by return of depressive symptoms, irritability, instability of mood, muscle stiffness, dizziness, headache, and insomnia.
What can we learn from the above?
1) If you are taking any psychotropic (mood changing) medications, don't adjust your dose without first consulting with the prescribing physician.
2)As side effects and direct effects can chang over time, if you experience any of the changes listed above while taking an antidepressant, call the fact to the attention of your physician. Questions about interference with ease of musical performance are still not yet part of the routine "review of symptoms" in medical practice. ~

John Levine is a psychiatrist in private practice in Cambridge, Massachusetts. and a Clinical Instructor in Psychiatriy at Harvard Medical School.

In an age of gadgets and techno-improvements, we tend to forget that technology doesn't make the world go around, people do. Unfortunately, flutists are just as susceptible as anyone else in believing that there are external answers to internal questions. In the last 22 years I've seen many flute players searching for some magical trick in the flutes and headjoints they buy hoping to find a special quality in them that no one else has.

But, aside from the basic quality of the instrument and a handful of options and innovations, the flute's real promise comes from you. Your self-confidence, determination and ability are the key elements in making a flute exceptional. They gives you the strength to step onto the stage and share a piece of yourself. Certainly, there are variations between manufacturers that give different flutes different qualities. But without the individuality of each flutist to bring them out the flute is just a tool.

When self-confidence is challenged due to a physical injury or hand problem, many flutists lose their way. For all the years of practice, study and performance sudden loss of ability will leave you totally unprepared. The trick is to return to the basics: confidence, determination and ability. Getting to whatever degree of skill you are at right now took incredible patience and determination. Use it again.

Take the time to research and find out what you need to do to recover. Whether it is having your flute modified to fit your hands, getting medical advice or treatment, retraining and developing better habits, don't back down once you realize that a problem exists. It doesn't matter if the cause of the problem was bad hand position, overpracticing, a car accident, arthritis or tendinitis the only solution you will find is within yourself. Your body is your instrument; your lungs, embouchure, fingers and mind. The flute is only an extension of that. You are the most critical and important part of the flute.