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Musicians and Injuries

Paul Marxhausen
http://eeshop.unl.edu/

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 J�as 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