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Gerald Klickstein

Heeding the signs of injury

January 20, 2011 at 7:07 PM

“I ignored all my body’s warning signals in the name of ‘dedication’ to what I was doing. I had absolutely no idea that this little problem would in fact threaten my career.”
–Christine Harrison, violinist (The Musician’s Way, p. 238)

We may not like to admit it, but we all have physical limits.

And given that music making is so physical, we musicians sometimes exceed our limits - much as dancers and athletes do - even when we're being proactive to prevent injuries.

Still, we can stop minor hurts from escalating into dire injuries, if we’re able to recognize and respond to our body’s warning signs.

Consequences of ignoring symptoms
I’ve learned that many musicians don’t appreciate the symptoms of injury. They’ll notice persistent pain in the wrist or hand, let's say, ringing in the ears, or the like, and they’ll push through the problem rather than backing off and seeking aid.

Yet to disregard such warning signs is to invite serious trouble.

As an example, here’s a post that a teen violinist wrote on allthingsstrings.com in 2009: 

I’m a student violinist and play in my high school orchestra. I have had tendinitis in my right wrist for about a year now. I really can’t rest my wrist for any period of time right now. I have several concerts and at least two upcoming competitions. The pain comes and goes depending on how much I use my wrist, but it never goes away completely. What should I do? Heather

I hope that things turned out well for Heather. But I suspect that her formidable injury could have been averted if she had known what to do when she felt that first ache.

And what about her priorities? After a year of pain (a year!), she thought that her upcoming performances were more important than her health. To boot, it appears that she didn’t know how to access expert local help.

We musicians need to be far more adept at caring for our wellbeing.

All of us, students and veterans alike, should understand the causes and symptoms of injuries and be equipped not only to avert problems but also to respond prudently when trouble knocks.

Plus, as artists, we must make wellness a priority because when we become unwell, our music making comes to a halt. 

A 3-step response to symptoms
Chapters 12 & 13 of my book, The Musician’s Way, spell out comprehensive strategies whereby we can promote health, prevent injuries, and deal wisely with symptoms. Here, I encapsulate some indications of injury and point to sensible responses.

Typical symptoms include pain, odd sensations such as tingling or numbness, fatigue, loss of control, and ringing or buzzing in the ears.

Such warning signs may turn up at varying levels of intensity, but when they persist, we should take three steps:

      1) Stop.  2) Rest.  3) Get help.

That is, for symptoms such as wrist pain, we should cease playing, curtail hand-intensive tasks, and seek help from teachers and medical experts.

Getting help
Musical authorities can commonly be found at conservatories and university music departments. Medical help can be accessed at campus health centers, from physicians, and, in particular, from arts medicine specialists, who practice in many urban areas – see the website of the Performing Arts Medical Association for referrals.

Of course, this simple-sounding recipe isn’t always easy to follow.

For instance, ensemble members might be counting on a hurting musician to perform at a high-paying show. In such a situation, a performer needing rest might see no option but to carry on.

Nonetheless, when symptoms loom, skilled helpers can aid performers to come up with various accommodations, many of which allow for degrees of practice and performance.

For example, a violin student experiencing her first occurrence of wrist pain might be advised to begin treatment with a physical therapist, take lessons from an Alexander technique teacher to gain ease in her playing, and participate in portions of rehearsals and performances with a substitute covering some of her duties.

But that’s just one scenario. We don’t have room here to catalog scores of others.

What we need to remember is that symptoms call for actions, and we shouldn’t try to go it alone.

Prompt action brings rapid recovery
The good news is that when symptoms are caught early, most musicians can carry out ‘relative rest,’ make modifications to their playing habits, and then gradually return to full-time music making without any detrimental effects.

Conversely, the longer symptoms are ignored, the more severe an injury tends to become and the more protracted the recovery period will be.

Occasionally, musicians who overlook warning signs learn that full recovery isn’t possible, as is the case with hearing loss, which is permanent.

*  *  *

In the past, musicians and arts institutions often behaved as if performers were indestructible: Groups would rehearse nonstop and at earsplitting sound levels; freelancers would gig incessantly and be struck down by strain and overuse.

I hope that present-day performers, educators, and music directors will heed the lessons of the past and put health promotion front and center.

A version of this article first appeared on The Musician's Way Blog. Additional health-promotion strategies can be accessed via the Wellness page at MusiciansWay.com.

© 2011 Gerald Klickstein


From di allen
Posted on January 20, 2011 at 10:13 PM

i have pain in right arm, bowing arm, in shoulder down to elbow, and sometimes, hand.....if i stop playing and take ibuprofen, it goes away.    but when i play again, it comes back.....is this serious enough to get medical help?  i am not young, and there is arthritis in my family.....


From Gerald Klickstein
Posted on January 20, 2011 at 10:54 PM

Thanks for the question. I say 'yes' - absolutely. A medical practitioner who is sensitive to musicians' needs could put you on a path to both relief from pain and optimal health. 

But choose help wisely - do some research to discover which healthcare providers in your area would be most knowledgeable about the physical aspects of violin playing.


From marjory lange
Posted on January 21, 2011 at 2:10 PM

 In your experience, is it ever too late to make useful changes, like starting Alexander Technique? I mean 'too late' in life-length, not in terms of injury.  I've just started A.T. and am coping with shoulder and neck problems associated with too many years of playing rather than practicing. So I wonder if it's worth it at this point (sorry to sound gloomy, but it's tough to have to face the consequences of years of inattention!)  Thanks.


From Gerald Klickstein
Posted on January 21, 2011 at 3:36 PM

Too late? Never! As sculptor Auguste Rodin wrote: "There is no beginning; start where you arrive." (Cathedrals of France)

I encourage you to dive into your Alexander technique lessons with an open heart - enjoy the blossoming of your self-awareness and the endless ways in which you can apply the technique to your playing and daily life.

So, rather than feeling any remorse about past mistakes, I hope you'll be inspired anew to create music, share it with others, and, in so doing, make the world a better place. 


From marjory lange
Posted on January 23, 2011 at 6:29 PM

 Thank you, especially for the Rodin quotation.  It's good advice for many things.  Marjory


From Bonny Buckley
Posted on January 24, 2011 at 1:58 AM

Pain while playing an instrument means something is wrong and has probably been learned incorrectly by the body and needs to be re-trained. There is a book called The Physiological Approach to Violin Playing by the Russian author Isaac Vigdorchik which should be required reading for anyone who is seriously studying violin or viola. When I got it I had to make a copy of a copy because it was out of print. I do not know the book's current status but I think it may be available. It would spare anyone the agony of a playing injury if it is followed as would the above great advice.


From Gerald Klickstein
Posted on January 24, 2011 at 2:26 AM

Hi Bonny - thanks for the comment. 

Although I agree that persistent playing-related pain means that something's wrong, I've learned that such symptoms don't exclusively arise from technical faults.

Often they do, and can therefore be addressed through rehab and retraining. But sometimes they stem from the likes of anatomical variations, diseases such as arthritis, overuse (e.g., excess repetition), and even drug interactions. Which is why it's vital for hurting musicians to seek expert medical help and not self-diagnose.

Thanks also for the book recommendation. Various online booksellers have used copies of Vigdorchik's text, and it can also be located in libraries worldwide via WorldCat.

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