Focus:

Why injury prevention is so important

September 13, 2013

The more we run from concert to concert, the less recovery time we allow our bodies

A recent study of professional orchestral musicians in Australia found that 50 per cent currently experience pain when playing. In this article from the April 2011 issue of The Strad, Janet Horvath gives some essential guidance on how to avoid injury and ensure a long and healthy career.

Playing a musical instrument is an amazing endeavour. But every time we pick up our instruments we are challenged on many levels. Everyone who plays or teaches knows that the demands of playing include precision, coordination, fluency, speed and skill. But it doesn’t stop there: as we learn to master our instruments, we are continually challenged by the hours of diligent practice necessary, the motivation and discipline required of us, the highly competitive environments we find ourselves in, and the tenacity and concentration we must display. Add to this list performance anxiety, the stress of auditions and competitions, and the pressure to learn copious
amounts of music, and we may have a recipe for disaster. Yet somehow, we cope with these challenges. In fact, we are often willing to do anything to make our performances happen – sometimes to our own detriment.

When we are young, our bodies are resilient and can recover quickly if we suffer pain. As we grow older, however, our cumulative playing time steadily increases and we are less able to adapt to the strenuous nature of our professions. Injury can easily occur and may become chronic, even in the youngest players.

When we have suffered repeated injury during our playing careers, we may reach what the noted physical therapist Jonathan Reynolds calls maximum exposure. This is the point at which a person’s muscles, tendons, ligaments and tissue have reached the limit of their capabilities. It is at this point that we might become chronically injured or suffer from pervasive pain and fatigue. It is not uncommon for significant stress and trauma to occur to soft tissue, resulting in tissue destruction and loss of function.

Each musician has a different maximum exposure or tissue tolerance. Our physical limit and injury susceptibility varies according to our age, sex, genetic make-up, fitness level, body size, build and pre-existing medical conditions. Tissue tolerance is also affected by our playing style. If you play in an intense, macho style, you are more at risk. Our work schedules are also a contributing factor: the more we run from concert to concert, the less recovery time we allow our bodies. Another issue is our injury history, especially if we have not allowed proper time for previous injuries to heal.

The general term for these kinds of injuries is overuse. Physical medicine and rehabilitation specialist Jennine Speier explains: ‘Overuse covers many conditions including tendinitis, bursitis, tears, arthritis and nerve entrapments. Sustaining these injuries can contribute to an eventual breakdown of tissue.’ Overuse can result in microscopic injuries to muscle tissue, tendons and ligaments. This type of injury is normal with vigorous activity and usually results in repair, creation of more muscle fibres and increased strength. ‘However,’ Speier continues, ‘when the overuse is too great there is inflammation. The results of inflammation can be pain and also the eventual development of scar tissue. At this stage, pain will not resolve quickly and the musician can note heaviness, weakness and impaired performance. Rest, reduction of inflammation with medication, and a gradual return to playing are part of the treatment to promote recovery. But if recovery is not followed through, the scar tissue can itself become an obstacle to normal muscle function, resulting in further injury and breakdown of tissue.’

There are few athletes who continue beyond their thirties. Musicians, however, have much longer careers. Hence for musicians, staying at peak performance throughout several decades poses additional challenges. We must notice the subtle and not-so-subtle changes in our bodies so that we avoid injury.

In a musical environment, there are many factors that contribute to reaching one’s limits. These include high levels of tension, long rehearsals, stress, technical demands, fatigue, posture, and a mismatch between the player, their instrument and their chair. But the main culprit is simply the repetitive nature of playing music.
We put stress on the same muscle groups every day as we perform repetitive movements, straining our muscles, tendons and ligaments. This initially causes fatigue, muscle imbalance, weakness and tightness, but without intervention it can lead to micro-trauma, inflammation and injury.

Some musicians, like some athletes, believe that more is better. But an abrupt change to practising harder, longer and with more intensity can quickly lead to overuse. Musicians often do not – or cannot – allow enough time for recovery and healing, resulting in chronic injury. Studies have shown that women are more vulnerable than men to injury, which may be due to anatomical differences such as their smaller body mass.

As we grow older, we must pay closer attention to these potential problems. Our bodies may become more prone to injury, in part because of changes to the muscles, bones, tendons and ligaments. As we age, our bones become less stable. Cartilage, the tissue that cushions the tips of the bones in our joints, tends to lose water, making joints more vulnerable to injury from repetitive motion and stress. Overuse can therefore contribute to our joints becoming less flexible and less resistant to wear and tear. Range of motion can be lost. The strength, size and endurance of muscle tissue may also erode.

Looking at the wider picture, we also lead busy lives. We try to deal with stresses such as ageing parents, growing children, and keeping up with the bills. We often don’t sleep well and we may not have the time to practise like we once did. Even if we are suffering from an injury, we might feel that we have to continue our work, and that we have no control over our gruelling and physically demanding schedules. Nevertheless, it is essential to be aware of the dangers, and there are simple preventative measures that we can take to reduce the risks of injury.

Preventative measures

1. Keep moving

After years of playing in the postures required by our instruments, asymmetrical body development may occur. Our resilience and capacity to recover may also decrease because we stop moving. Inactivity accelerates muscle and bone loss, and it may contribute to stiffness. Research indicates that we can reduce the long-term risk of osteoporosis by regularly performing weight-bearing exercises such as walking or weightlifting.

It is essential that musicians have good flexibility in order to avoid injuries connected with overuse. Good flexibility enables your body to align properly. Strengthening exercises and aerobic conditioning are very important in improving endurance. But you should consult a professional before you try any new exercise. If you feel pain or stiffness, a physical therapist or a trainer who understands musicians’ issues can help by creating a training regime to fit your needs and correct your body alignment, as well as alerting you to effective injury-prevention exercises. Yoga, Feldenkrais and Pilates are all disciplines that are safe for musicians of any age, and they are wonderful for circulation and flexibility.

2. Be prepared and stay in shape

More is not better: practise smarter, not harder. Our motions tend to be jerky when we don’t know what is coming up in the music. Plan fingerings and study the music – you will be more likely to maintain ease and flow in your body motions. If you have taken several days off, always get back into condition gradually. Try to be consistent with practice, so that your body is prepared. Do not increase your practice load abruptly if you are preparing for a major performance or competition.

3. Warm up slowly and thoroughly

Muscles must be actively moved in order to increase blood circulation and deliver a greater amount of oxygen and nutrition to cells. Moving slowly loosens tendons and the connective fascia tissue, allowing them to become more flexible and pliable. Warming up also generates a greater release of synovial fluid, allowing your bones to slide on each other with greater ease. Warm up away from the instrument first. A few minutes of aerobic exercise – a brisk walk or even jumping on the spot – will do the trick. Then warm up at your instrument, playing in the middle of the range and at a medium speed. The key is to start gradually.

4. Examine your technique

Release at every opportunity, especially your fingers and thumbs. Don’t hold awkward positions. Releasing and lifting quickly allows for a lighter, faster technique. Keep your shoulders down, your torso facing forwards, and your head in a neutral and upright position. Alternate standing and sitting if your instrument allows you to do so.

5. Take more breaks

A few minutes’ break every hour helps to alleviate any tension that may build up. An athlete can recover easily from a sprint but will take two or more weeks to recover from a marathon. The same is true for musicians, so make sure you allow yourself time to recover from a performance. Even while performing, you can keep tension at bay by rolling your shoulders, adjusting your seating, letting your arms hang down, and moving and wiggling whenever possible.

6. Adjust your equipment to fit your needs

If you wear glasses, make sure that they are the correct prescription. Place your music stand directly in front of you at eye level. To see your music properly, move your instrument rather than twisting your body. When you are seated, your knees should descend from your hips so that your weight is on your feet and forward, and so that there is a natural lumbar curve in your back. Buy and use ergonomic cushions so that your chair is at a proper height for you.

Make sure that your instrument is adjusted so that it is as easy to play as possible. For upper string players, this includes using chin rests and shoulder pads that fit properly; for cellists, lowering the height of your strings is important in order to reduce strain. All string players should use instruments that are light in weight and properly sized for them. Carry earplugs with you at all times for unexpected assaults of loud volumes, and wear them when noise goes beyond your tolerance.

7. Stop when you are tired or if you feel pain

Fatigue is often the first sign of trouble. If something that you could easily execute a few days previously suddenly feels difficult, pay attention. Avoid forcing tired limbs. Try to take some time off and examine what you might have done before pain sets in. Get help sooner rather than later – as with any injury, a full recovery is more likely if you nip the problem in the bud. If you feel any numbness, get it investigated immediately: numbness may be a sign of a nerve problem. Involuntary movement or the feeling of a finger not doing what you want it to do without pain can also be a sign of impending injury. Err on the side of caution: take a break, and get it investigated.

Our goal as musicians is to play within our own tissue tolerance by monitoring our posture and the force and intensity with which we play, and by limiting the duration and repetition of playing from day to day. Keeping tabs on how your body feels and making any necessary adjustments will mean that you can continue to play for years to come.

To read more articles on important issues for string players, subscribe to The Strad or download our digital edition as part of a 30-day free trial.

We must notice the subtle and not-so-subtle changes in our bodies so that we avoid injury
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