Musicians and Injuries
Maybe it's a nagging ache in your thumbs, every time you practice at
the piano. Perhaps there have been long rehearsals for that crucial
recital, and now you notice stabbing pains in your forearms. Or you
find yourself struggling with hands that have become increasingly clumsy,
or numb. It may be that you are even waking up at night with pain in
your arms, or your back, or your neck. Well, it's just a part of being
a serious musician, right? And after all, you can't stop
practicing - there's too much at stake, and music is your very life!
Does this sound familiar?
Instrumental musicians are a special risk group for repetitive motion
injuries. Sizable percentages of them develop physical problems related
to playing their instruments; and if they are also computer users, their
risks are compounded and complicated. My own computer-induced tendinitis
was very much aggravated by my guitar and violin playing and did not
begin to improve until I stopped all playing for several months.
Instrumental injuries often include the same conditions experienced from computer overuse : Carpal Tunnel Syndrome , Tendinitis, Bursitis , Tenosynovitis / DeQuervain's Syndrome , Tendinosis , Thoracic Outlet
Syndrome, Myofascial Pain Syndrome, Cubital Tunnel Syndrome, and Trigger Finger/Thumb are particularly common among keyboardists, fretboardists, flute, and
string players. But the particular demands of different instruments produce
other problems as well, including hearing loss or TemporoMandibular Joints Disorder. (Additional TMJ leaflets: 1, 2, 3, 4, or
this new site from the TMJ Association ).
Incorrect posture, non-ergonomic technique, excessive force,
overuse, stress, and insufficient
rest contribute to chronic injuries that can cause great pain, disability,
and the end of careers.
But while these problems are unfortunately common, it's NOT an
unavoidable part of being a musician. If we're willing to listen to
what's being learned in the field of arts medicine, we may be able to
escape the bullet of occupational injury and recover our ability to play.
What Can You Do?
- INFORM YOURSELF. Take time to read the resources listed below.
Causes and prevention are a complex topic, as Jï¿½as Sen's excellent thesis makes clear.
- EVALUATE YOUR TECHNIQUE. Again, the materials listed
have much more information, but in general musicians often need to
reduce force, find postures that keep joints in the middle of their range
of motion, use larger muscle groups when possible, and reduce body usage
that involves fixed, tensed positions.
- ALWAYS WARM UP. Athletes do not abruptly start vigorous
physical activity without warming up and stretching because they know
it is an invitation to injury. Musicians are putting athletic demands
on fine motor musculature and should similarly be religious about
warming up before practice or performance.
- TAKE LOTS OF BREAKS TO STRETCH and RELAX. This means both
momentary breaks every few minutes and longer breaks every hour or so. This may be the single most important thing to remember. Constant tension and repetitive motion does not allow the body to flush
away metabolic waste products and this is traumatic to tissues over time.
Even in the middle of playing a piece you may have a moment to relax a
hand or arm to restore circulation. The marathon
rehearsals that musicians pride themselves on have great potential to hurt us.
Emerging research on athletes reveals that overtraining actually decreases
performance. Try two or more shorter rehearsals in a day rather than one long, intense
session, and limit total time on your instrument.
- PACE YOURSELF. It is very common for musicians to notice injury
when we are...
- preparing for recitals or concerts
- attending music camps
- heavily involved in multiple musical groups
...not surprising, because all of these can radically increase our
playing time and exceed the limits of our body. (Yes, even for young people,
who feel invincible. I have seen more than one gifted high school string
player in my city seriously injured in this way.) Learning to pace ourselves and learning to say "No" to some playing is critical.
GET MEDICAL HELP. Therapists and doctors know that musicians are notoriously hard to persuade
to reduce or stop their playing to allow injuries to heal, and some
instructors (or even parents) may tell students to ignore pain, or accuse them of trying
to avoid practice. But "No Pain, No Gain" is a disasterous policy for
a musician. If it hurts, back off. THIS IS SERIOUS STUFF: is it worse to have to not
play for a few months . . . or to risk a permanent injury, disability,
pain, and never playing again? Also, I hear of musicians with pain who
are afraid to see a doctor because they may find out they have a difficult
injury. It's better to know the truth and do something about it. Don't put off seeking treatment if you are in pain. Use the FindADoc Web page to locate
knowledgeable medical care.
- EVALUATE OTHER ACTIVITIES. Your problems may be caused or
aggravated by other things you do frequently. Computer use is a notorious example,
but sports, carrying children, hobbies, and excess effort/tension in
other daily things may have enormous impact too.
- PAY ATTENTION TO YOUR BODY. Pain is your body yelling that
it's in big trouble, but learning what is comfortable or awkward for your
body before you're in pain may prevent injury. "Physical re-education" through The Feldenkrais Method, T'ai Chi, yoga , The Alexander Technique , stretching,
or dance classes all may be helpful.
- CHECK OUT YOUR INSTRUMENT. Are you using an instrument that is
too large or awkward for you? Is it set up optimally for you? Could you use lighter
strings or reeds? Is there a strap or stand that could make playing less stressful?
If it's big and heavy (like a string bass), can you get a cart to help transport it?
And remember: if it is a new instrument, especially a larger one, you
need to take time to adjust to it before you plunge into intense use of it.
- BE CAREFUL WITH STRENGTHENING METHODS. Building up muscle strength
with special devices (GripMaster, putty) or musical exercises (Hanon) is very
controversial. If you are already injured and in pain, such things may make
it worse. And overdoing musical exercises while using bad technique,
poor posture, or too much force may only speed you along to trouble.
On the other hand, if you are not yet injured, or are
undergoing rehabilitative therapy, properly conditioning muscles may help prevent injury or
re-injury. Be patient in building strength, and talk to a
qualified doctor or physical therapist
I'll be putting more information here as I am able, but for now I highly
recommend looking at some of the resources listed below. If you have pointers
to similar literature, especially ergonomically oriented instrumental methods, or
just have a tip or two of your own on safer techniques and injury prevention/recovery,
drop a line so it can be added here. Please note that authorities in this
area of study have differences of opinion about points of technique, treatment,
or prevention: read as much as you can for the balanced view. Please note
that several of the "reviews" below are written by persons other than myself:
these have quotation marks and attributions to distinguish them. -Paul Marxhausen