Musician’s Injuries

Maybe it's a nagging ache in your thumbs, every time you practice. Perhaps there have been long rehearsals for that crucial recital, and now you notice stabbing pains in your shoulders. 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?

In 1838 Robert Schumann wrote:

“All the music is complete and alive within me, so that I wish to effortlessly breathe it out, but now I can hardly bring it forth; I trip over one finger with the other. This is truly frightening and has already caused me much pain.”

This quote epitomizes the fervor of every musician that suffers with a condition that hinders the ability to express a musical idea and the ability to earn a living. Even recently, the medical and public perception is that musicians are doing what they love to do and therefore should put up with their pain and dysfunction. Like athletes, musicians perform for the public; and like professional athletes, they can lose their jobs if they don’t perform. But only athletes work with physicians and physiotherapists almost daily. Treating a professional or an amateur musician is synonymous with treating an elite athlete. Injuries are not uncommon and can be devastating for the musician as an individual - and for the orchestral team.

A manual / manipulative physiotherapist is a valuable asset to the team for both prevention of injury, and for treatment in the unfortunate event of injury.

  • Consultations at P3 Physiotherapy are by appointment only
  • Book a minimum of one hour with one of our qualified physiotherapists
  • Bring any test results or reports from other health professionals you have seen including written reports and x-ray/CT Scan/MRI reports
  • Bring your instrument!
  • Wear clothing that allows us to see the painful areas of your body while you play
  • We use photographs or videotaping if necessary
  • Professional musicians join in as our consultants whenever this is possible

We are pleased to note that the fact that the physiotherapists at P3 Physiotherapy are not musicians has been an asset rather than a liability. Musicians do not object playing for me once they realize that we have no preconceived notions about how they “should” play. We will simply be watching the biomechanics of playing and what they do to the human body. Most musicians soon realize that their talent astounds us, so they relax and give excellent demonstrations of their habitual playing postures and positions. Over the years they have also patiently taught us about their instruments and common problems. We continue to learn as much as possible from each other.

The musician is assessed thoroughly by the physiotherapist initially. All musicians bring in their instruments and we do a thorough playing analysis to see – mechanically - what it is that they're doing and what might be changed to alleviate pain without affecting sound quality. It often is that posture is contributing to injury. Or maybe there's something about the instrument that we could change; it might just need a minor adjustment in the thumb rest or a key positioning. The musician then attempts exercises, stretches and changes we have suggested. Some musicians only need that one visit. For those who need a course of injury specific physiotherapy treatment, this can be provided at our facility. Injury prevention is an inherent component of physiotherapy.

Music teachers, who have participated, both as patients and advisors, have enlightened us with their positive responses. Once they have been exposed to basic anatomy and athletic protocols, many can hardly wait to try out these new ideas with their pupils and to give us the benefit of their own experiences and experiments. Music teachers, in our opinion, are the main line of defense against playing injuries for the generations to come.

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 musician’s are willing to listen to what's being learned in the field of arts medicine, many may be able to escape the bullet of occupational injury and recover their ability to play.

What Can You Do?

INFORM YOURSELF
See a physiotherapist
Use the internet to research your injury

EVALUATE YOUR MECHANICS
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
Playing cold is an invitation to injury. Athletes do not abruptly start vigorous physical activity without warming up and stretching because they know this through experience. Musicians are putting athletic demands on fine motor musculature and should similarly be diligent about warming up before practice or performance.

TAKE REGULAR BREAKS TO STRETCH and RELAX
This means both momentary breaks every few minutes and longer breaks every hour or so. Constant tension and repetitive motion does not allow the body to flush waste products and this is traumatic to tissues over time. Try two or more shorter rehearsals in a day rather than one long, intense session, and limit total time on your instrument.

PACE YOURSELF
Learning to pace ourselves and learning to say "No" to some playing is critical.

GET MEDICAL HELP
Physiotherapists 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 disastrous 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? Don't put off seeking treatment if you are in pain.

EXAMINE OTHER ACTIVITIES
Your problems may be caused or aggravated by other things you do frequently. Using a computer is a notorious example. Sports, carrying children, hobbies, and excess effort/tension in other daily things may have enormous impact too.

LISTEN TO YOUR BODY’S SIGNALS
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", stretching, or Pilates may be helpful.

ASSESS 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 or musical exercises is very controversial. 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 physiotherapist.

Specific Injuries

Carpal Tunnel Syndrome
Characterized by a tingling sensation or numbness of the thumb, index and middle finger.

Tendinitis
Inflammation or irritation of the tendons .

Bursitis
Inflammation or irritation of a bursa (a sac of fluid that prevents two structures from rubbing on each other.

DeQuervain's Tenosynovitis
Characterized by pain on the inside of the wrist and forearm. Thoracic Outlet Syndrome May be either neurological or vascular characterized by pain, swelling or puffiness in the arms and hands, neck and shoulder pains, muscle weakness, difficulty gripping objects, muscle cramps and tingling or numbness in the neck and shoulders and arms.

There are many more potential injuries that are related to music instrument playing, most of which are caused by overuse, repetitive strain, wrong posture and wrong positioning of the body, arms, legs, hands and fingers while playing an instrument. It is very important to consult your physiotherapist if you are experiencing aches and pains or are in danger of serious injury.

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