Playing is all about repetition so overuse can be synonymous with a music career. Proper posture and holding an instrument correctly are key to avoiding strain. And, because certain muscles are used repeatedly when playing, musicians should take care not to overuse those muscles during other daily activities.
If possible, hold joints in a neutral position. For example, to prevent wrist tendonitis, keep your wrist in a straight position when not playing, instead of extremely bent or flexed. This will help alleviate the added stress placed on tendons during a performance. Also, as a preventative exercise, be sure to stretch regularly.
Early intervention means you should not play through the pain. Immediate treatment is essential to prevent long-term injury. Pay attention to your pain, noting changes or increases. Encourage students to tell parents or teachers when they experience pain. Teachers should also be alert to changes in a student’s technique or style.
Tendonitis vs. Tendonosis
Naming the pain is important. Tendonitis is inflammation (redness, swelling, heat, soreness) that occurs when the immune system detects an injury and responds. The body increases the flow of blood and infection-fighting substances to the injured tendon.
Tendonosis is a degenerative injury that does not prompt an immune response. It occurs when repetitive stress over time causes the breakdown of collagen, growth of abnormal blood vessels, and thickening of the tendon’s sheath. Research suggests that many injuries diagnosed as tendonitis are actually tendonosis.
Repeated or sustained muscular contraction associated with mastering virtually any musical instrument causes a decrease in blood flow to the working muscles and tendons. In the case of overuse injuries, the body is signaled to repair muscles that are not really damaged. The result is accumulation of scar tissue in otherwise healthy muscles and tendons, which increases stress on the tendons causing them to begin to degenerate.
Scar tissue prevents normal stretching and limits muscle contraction. This can cause decreased range of motion, decreased strength, fatigue, and pain. Physicians say pain is often the last symptom. The involved muscle is then weakened, requiring neighboring muscles to overwork. This cycle of increasing stress, buildup of scar tissue, and degeneration continues until the body can no longer compensate. The result is chronic pain.
Intermission—Take a Break!
If you have an audition, concert, or festival coming up, do not rehearse all night. Spread out practice sessions. Take a break after about 45 minutes, whenever possible. Researchers say the instance of injury goes up dramatically after 45 minutes of continuous activity. Adequate rest reduces muscle tension as do proper posture and body mechanics.
Also, do not dramatically increase playing time. As athletes can attest, this presents high injury risk. An average 5K runner would not suddenly run a marathon. In the off-season, athletes cross-train. So, when not at festivals, concerts, or auditions, take time to do other activities and exercises.
Strengthen to the Core
Cardiovascular exercise and moving in general are important, especially for musicians who spend a lot of time sitting. Critical to handling, moving, and supporting instruments is strengthening other muscles: the core, upper back, and shoulders all support areas of your body used when playing.
Back pain and pain of the upper extremities are common, whether it’s shoulder pain for high string and flute players or elbow strain for violinists. Bowing techniques put strain on the right shoulder and elbow. Brass players may have back pain, consistent with having to support heavy instruments. The list goes on.
For Good Measure
Watch a video of your performance or practice to critically review your stance and playing position. Ask yourself: Do I seem to have excessive tension? Where is that tension showing up? Is it one-sided? Does it appear in my shoulders, in my hands? Do I make any extraneous movements? Do I move too much or too little?
Remember, to avoid injuries and recover from minor pains: use proper posture and body mechanics, stretch often, build your muscle strength and endurance through exercise, ramp up your playing gradually, and take frequent breaks. Always consult a physician at the first indication of pain or injury.