To get the most out of the following information, please read the two previous posts in which I discussed neutral posture (in contrast to the posture most of us have been taught is “correct”), ways in which the holding and playing of an instrument affects the body of the musician, and specific physical problems one might experience from playing an instrument and possible ways to address them.
In this post I’ll discuss treatments and exercises.
The information presented here is not a substitute for professional medical diagnosis and care.
Simple Exercises for Injury Prevention
Once an injury has occurred, it is essential to stop doing the thing that caused it. This means permanently changing your posture and/or hand position and/or technique. The necessary changes will not necessarily be easy or feel natural right away; they may require patience and focused retraining. I can hear the shrieks of protest already! “But I had to work hard to learn my technique!” and “But it’s too hard to break old habits!” and “I just want to have it get better by reading about it, but I don’t want to DO anything differently!”
So ask yourself this question: would you rather end up not being able to play at all due to permanent injury (yes, new injuries can become permanent ones if you don’t change the technique, posture, or habit that injured you), or would you rather do whatever it takes to be able to play comfortably for a lifetime?
It may seem, when discomfort first develops, that it’s not bad enough to give much attention to. As the pain grows, we start hoping it will just go away. Usually, however, it just keeps getting worse. At best it keeps us from enjoying playing our instrument, and at worst it eventually makes playing impossible.
Muscles get stressed and inflamed from excessively repetitive or constantly fixed flexion (contraction). In other words, they get stiff and painful when they’ve been used too much. This is a sign of damage to muscle tissue, tendons, tendon sheaths, nerves and/or nerve sheaths. Musicians can get tendonitis (inflamed tendons), tenosynovitis (swelling of tendon sheaths), carpal tunnel syndrome (inflammation of tendon sheaths in the wrist area), thoracic outlet syndrome (enlargement and hardening of muscles in the neck area, which causes pinching of nerves and blood vessels), and a number of other conditions that should not be ignored. A healthy muscle is one that is stretched as much as it is flexed. Musicians too often don’t stretch the muscles they use for playing their instruments, so chronic tension from constant or repetitive flexion builds up and those muscles and tendons eventually refuse to move well at all. These conditions can usually be reversed.
In addition to the possibility of hand, wrist, arm, back, neck and/or hip discomfort, some musicians suffer from rotator cuff injuries. The rotator cuff is the group of muscles at the shoulder joint. If you have pain in the joint area of the shoulder that will not go away, don’t try to strengthen the area until after you’ve had medical intervention. See a medical specialist and get an MRI. Rotator cuff injuries often involve a tear in muscle tissue, a detached tendon, bursitis, or other conditions that are exacerbated by further motion. Bursitis (inflammation within the joint itself) can be very effectively treated with one or two cortisone shots in the joint; it’s a surprisingly easy solution, and short-term cortisone treatment is not harmful to the body. But muscle tears and tendon detachments must usually be surgically corrected. Some folks are afraid to get the surgery, but if you’ve got a good surgeon (check his or her reputation), it’s so worth it, usually resulting in complete and painless use of the joint. Recovery after the surgery usually requires several months of physical therapy, but it’s much better than a lifetime of pain.
For discomfort in areas other than the rotator cuff, here are some exercises that can help the muscles used in playing. They should be done GENTLY to avoid further stress to the affected muscles and tendons.
Exercise 1: Hold your arm and hand as though balancing a tray. Elbow should be bent all the way and palm facing the ceiling. Now, keeping the wrist bent, leading with the heel of the hand, slowly straighten the arm out in front of you until it looks as if you are stopping traffic. Stretch the ball of the hand forward and stretch the fingers upward. Then drop the hand forward and bring the arm back until the wrist is close to the shoulder again. Do this with both hands. Be gentle with yourself. You should feel some pull but no sharp pain.
Exercise 2: Dangle your arm at your side, palm facing the body. Keeping the elbow straight, bring the hand upward into a cupped position. The hand and arm will form the shape of a “J.” Now rotate the hand at the wrist, one direction and then the other, as far as it will go without straining. Gently shake the hand out when done.
Exercise 3: Get some Chinese hand-exercise balls. These are available at most import shops, New Age stores, and some music catalogs. Choose a size that fits comfortably in your hand when both balls are held in the same hand. Rotate them around each other in one direction and then the other. Do this no more than three or four minutes a day. Not recommended for those with severe tendonitis.
Exercise 4: Hunch your shoulders upward toward your ears as far as they will go, hold a few seconds, drop them and shake them gently back and forth. Repeat three times.
Exercise 5: Make a half-circle with your shoulder by moving it straight forward, then up to your ear, then back. Repeat several times, and then change direction. When you get good at it, you can make a full circle by adding a downward push as you move from back to front.
Exercise 6: While standing or sitting straight, drop the head to one side so that you feel a stretch in your neck. Hold for one or two seconds, then do the other side. Repeat three times.
IMHO, the very best physical activity for musicians is yoga. A good yoga routine stretches, tones, and brings better circulation to all the muscles of the body. Those who do yoga regularly almost never have any issues with discomfort related to playing an instrument.
The best treatment for injured muscles and tendons is rest. That means stop using them! If, for instance, your right hand hurts, not only should you stop playing for several weeks, but stop using the hand for other things as well. Comb your hair, brush your teeth, open doors, and carry things with the other hand. Seriously. This isn’t overkill – it’s necessary.
Many folks reach for the painkiller and then keep playing. That just makes the injury worse. Pain exists to tell us something is wrong! It’s telling us to stop using the painful part. Don’t ignore the body’s wisdom. Just masking pain and inflammation does not fix the injury; it only allows us to live in denial for a while longer. What’s more, although NSAIDS (the class of drugs that includes Advil and Aleve) can reduce pain and inflammation, they should only be taken for a few weeks at most. Long-term use of NSAIDS can wreak havoc with the delicate tissues of the digestive system, just as aspirin does with the stomach lining.
It’s common to apply ice packs to painful areas. When a muscle or tendon has been severely strained and is swollen, hot, and the surrounding tissue is red, using ice can reduce swelling. (Icing only helps if you stop doing what caused the problem and let the injured area rest for at least a few weeks.)
However, when an injury has come on slowly and there is pain but no inflammation, ice has been known to make it feel worse; try dry heat, such as a heating pad. Dry heat can relax the injured tendon or muscle, and increases circulation to the area.
If, after a few weeks of resting the affected area, the pain and/or swelling does not subside completely, see a specialist. Beware of sports therapy; music is not a sport and the cause of the injury is not the same. Therefore the treatment of your injury should be very different from sports injury treatment.
Once your discomfort has eased or disappeared, don’t go back to doing the thing that injured you in the first place. Once injured, the affected part will usually be quite susceptible to re-injury. Learn a new technique, learn neutral posture, etc.
Concerns of Beginners
Beginners almost always get sore fingertips from fretting or plucking strings, sore muscles in the hands from stretching in ways they’ve never stretched before, and maybe soreness in the arms. Beginners need to limit their playing time to avoid developing injury from overuse, not to mention blisters. It’s a good idea to accept that there will be some discomfort until callouses develop and muscles get accustomed to stretching. But if there is pain the joints, wrist, neck, back, shoulders or hips, that’s not normal. Nor is prolonged discomfort (more than a few weeks) of the fingers, hands or arms.
Beginners very often try too hard physically. Playing an instrument is not like wrestling or weight-lifting. On fretted instruments there is a tendency to press way too hard on the fretboard, as though the strings were wild beasts needing to be tamed. One needs to press only as hard as it takes to get the string to sound clearly (which is a matter of finesse, not strength), and be sure your finger is just behind the fret bar rather than in the middle of the space between frets.
On harps, beginners often stiffen their hands just to pluck strings. Instead, learning a relaxed technique that also brings out the best tone is what is needed. Be sure you have a good teacher, and see The Harper’s Manual, available from the books page at www.laurieriley.com .
On wind instruments, beginners often press down too hard on the holes or keys. It’s not how hard you press, but how well you cover the entire hole that matters – again, it’s finesse, not strength. For flutes with no keys, rather than pressing harder, try rolling the finger a bit so it covers the hole better. If your fingertips just aren’t big enough or your fingers will not reach all the holes, get a flute that is made for smaller hands, or get some keys installed. If you have a keyed flute and the pads do not adequately cover the holes with an easy touch, get your flute re-padded!
No matter your instrument, a good teacher should notice if you’re tense when playing, or if you’re trying to use too much muscle strength, and should advise you appropriately. If they don’t, it’s up to you to point out any discomfort or tension you feel so your teacher can help you address it.
Next week: All About Hands