Interview with Diana Rumrill: Preventing and Treating Violin-Related Injury
March 10, 2010 at 5:48 PM
The awkward nature of the violin can prove more than a matter of inconvenience: it can actually cause physical injury.
Fortunately, one can manage and even prevent aches, pains and injuries with the proper approach -- this is where Washington, D.C. violinist Diana Rumrill comes in. Not only has she been playing the violin for 30 years, but she also has been a physical therapist for ten years. As a physical therapist she has worked at the National Rehabilitation Center and has a private practice called Harmonious Bodies in D.C., exclusively for musicians. She also gives workshops and has some great podcasts on her website, including podcast interview with Alice Brandfonbrener, the great pioneer of performance medicine.
I had the opportunity to pick Diana's brain about injuries that are unique to violinists, how to prevent and treat them, and how to promote overall health in the violinist. Read and be healthy!
Laurie: For what kinds of injuries are violinists most at risk?
Diana: Violinists tend to be prone to back, neck, shoulder, forearm, wrist, and hand pain. This can be from irritation of muscles and tendons, or from compression of nerves. All of these issues can be helped by changing the way you practice to work with your body rather than against it.
Laurie: What specific techniques can help a violinist avoid specific kinds of injuries?
Diana: Learning to have a feeling of freedom throughout the whole body as you play will help with a multitude of issues. This is a middle ground between floppiness (slump-type posture) and bracing and stiffening the body (military-type posture) in which you feel free to move in any direction while retaining a sense of security. Bracing tends to be more of a problem for highly motivated musicians. Finding this balance of just the right amount of muscle tension will not only reduce playing related pain, but will help you play more expressively and freely.
Let’s look at how this plays out in different areas of the body. Maybe you were taught to be a good orchestra player by sitting up with your back arched and your violin raised high. This posture has good intentions, but your back muscles will be working overtime and your shoulder blade movement will be restricted. This eventually produces pain in the back and limits your available bow arm movement.
To find just the right sitting position, first find the bones you sit on. You want to sit centered on these bones. Gently rock back and forth on your sit bones while you release unnecessary tension in your back muscles. Once you find a comfortable middle ground on your sit bones, bring your violin up to playing position with freedom in your arms, leaving your back alone. You should be able to easily look up at the conductor without arching your back to do so.
Another area violinists tend to brace in is the contact with the chin and shoulder rest. Your fingering will be more free, your left arm will get good blood flow and feel relaxed, and your neck will feel better if you think of the violin as a sort of dynamic bridge between the neck and left hand rather than a shelf that the neck clamps on to. The left hand and shoulder/neck can change their balance of support as you play, like a dance, rather than a bridge riveted in place. The front of the chest then can feel open from collarbone to collarbone, leaving plenty of space to move.
Also, be open-minded as to what equipment might help you best. You might be surprised at the freedom a different type of shoulder rest or a middle mounted chin rest may afford if you have always stuck with the same setup. Consult your teacher or a performing arts medicine specialist on available options.
Laurie: How can one practice correctly, in a way that avoids injury?
Diana: First, avoid the idea that repetition equals practice. This is especially important if you are prone to finger or forearm pain. These small muscles get more than enough action in today’s keyboard – centered lives with computers and cell phones. Add in six hours of Bach sixteenth notes and you have a recipe for inflamed tendons, especially with the added tension level that stress brings. This is like trying to sprint a whole marathon!
If you are breathing freely, you are allowing movement to occur as well as sending a message to your body to be calm. This sounds like very simple advice, but one of the most common habits we all have in times of stress is to breathe shallowly or to hold the breath altogether for periods of time.
Maintain an awareness and relaxed visual scan on the room while practicing or playing. Having a narrow focus and staring at music for long periods creates a tendency to tense and brace the eye, neck, and forward-pulling muscles of the shoulders and trunk. Make sure your music is at the proper height so you can see it without slouching or squinting.
Drink enough water to properly lubricate your tendons. The finger muscles are driven by tendons in the forearm, which ride in tendon sheaths. Dry tendon sheaths mean friction and pain. Finish a thirty-two ounce water bottle twice in a day and you’re done.
Use a principle of strength training in your practice, which alternates different types of body stresses to avoid overdoing. Warm up by starting with something familiar at an easy pace. Alternate difficult or faster repertoire with slower or easier. Take regular breaks: walking around the room, drinking water, deep breathing, and gently stretching, every twenty to thirty minutes. Besides grounding you and allowing you to be more present and able to concentrate, your muscles need recovery time out of playing position.
Laurie: What is the best kind of general exercise for a violinist? Are there exercises (outside of playing) that can actually worsen the risk of injury for a violinist?
Diana: Many musicians mistakenly think that because they move their hands and fingers a great deal, that area is what needs strengthening. Actually, the opposite is true!
Musicians need strengthening of the large, torso-supporting muscles of the abdomen, back, shoulders, and hips in order to take the strain off of these small muscles. The wrists and fingers get overworked with the instrument and almost never need additional strengthening work with violinists. Yoga and Pilates classes are good choices. Better yet, if you are unsure where to begin, have a physical therapist work with you to develop a fitness program for you for home or the gym.
Take care of your body. Many musicians weren’t drawn to sports as children, and may find it difficult to think of themselves as “athletes”. However, our entire bodies were designed for movement and won’t work their best without a regular cardio workout. This means exercise that makes you breathe harder and is sustained for a period of time. Thirty minutes a day of walking, jogging, biking, or swimming will do it. Schedule it into your daily calendar, and once you have developed a habit, you will notice that you miss it if you skip a day.
I highly recommend working one on one with an Alexander technique teacher to help you find ways to stand, sit, and play the violin freely and without extra tension. There are resources at www.alexandertechnique.com, as well as podcasts on my website www.harmoniousbodies.com to find out more and to learn how you can work with a teacher in your area.
Laurie: If a musician is already injured, what steps should they follow in order to get a correct diagnosis and treatment?
Diana: If pain or other symptoms do not go away after altering your practice habits and do not subside after a few days of rest, it is time to seek medical help. It is much easier to treat a problem that has been going on for a few weeks than a few months or years! Don’t wait until the week before your big recital to run to your doctor in a panic.
Pain is a signal that something needs attention, and it’s hard to effectively treat pain in a rush. It is especially important to get help if you have neurological symptoms such as numbness, tingling, or writers’ cramp type feelings.
The Performing Arts Medicine Association has a “Referrals” section on its website in order to look up medical professionals in your area who specialize in the treatment of musicians. It’s best, if possible, to see a professional who already understands performers’ needs; if not possible, be prepared to explain the specifics of your instrument and your schedule. Definitely bring your instrument to your appointment, and tell your provider exactly when the problem started, whether there have been changes in your routine or stress level that preceded it, what specific activities provoke your symptoms or improve them, and any other information you have that will help them treat you effectively.
Laurie: Is there anything that needs changing, in the teaching of violinists, to help them avoid future injury?
Diana: Violinists should be taught with a sense of perspective about life away from the violin, a sense of fun and play about music as well as “the serious stuff”, and healthy cooperation with others to help balance an excessive pressure to succeed that ofter precedes unhealthy practicing habits.
Teachers should also keep in mind that every violinist is not appropriate for the same repertoire or the same fingerings. Work with the student’s body type and personality rather than against it.
Laurie: Is there such thing as "too much practice"?
Diana: Yes. Practice that feels like logging hours, mindless repetition of the same passages, and most especially is painful is not helping you physically or artistically. You already have creativity – now use it to come up with ways to help you learn your piece without simply repeating the passage over and over in the same old way.
Here are a few ideas to get you started: Set a five minute timer and play the passage as many different ways as you can in that time – in the style of different artists, with different speeds, bringing full attention to your breathing one time, full attention to your feet on the floor another time, et cetera. Try practicing the passage as softly as you can, without a mute. This helps you develop sensitivity and lets you really hear yourself, and can be a great side benefit of playing when you have to be mindful of disturbing others. Try alternating playing the passage aloud with “playing” it in your mind, really wxperiencing the sound and feel of playing the passage the way you want to do it. You may notice sensations arising during your mental practice that you notice before. For example, you have a sensation of squeezing the violin harder with your shoulder during a difficult part or bowing heavily when it’s not needed. When you notice and correct these during the mental practice, you have a chance to correct them during the violin practice, and you didn’t even have to irritate your tendons to do it!
Thanks for the advice. I'm going to watch/listen to your podcasts. Everything you said in the interview sounded sensible and helpful. I have a severe case of TMJ and various aches in my upper body that are related to playing the violin, so I especially appreciate your advice on relaxing the body. I also teach health-related violin issues to my violin students, so they will benefit from what I've learned from you. Thanks again.
This is a brief testimonial for Pilates and Alexander Technique. (I've done a little Yoga, but as a fairly conservative Christian, the spiritual aspects didn't personally sit well with me so I stopped. However, it did help my playing and was very good for my flexibility and ability to relax). I've been taking Pilates for the last 4 weeks and it has made huge improvements in the way my lower back feels when I'm done playing. I used to have quite a bit of pain in my lower back after orchestra rehearsal, but after applying the basic Pilates principles to my playing, my lower back feels great afterward. Last night I played a concert and my neck was very sore afterward. I took my very first Alexander Technique lesson with Diane Faust at Viterbo University today. I played the exact same concert again tonight and my neck was completely pain and tension-free. Wow! I highly recommend adding these to your life. I'm 22 years old, and I'm glad I'm learning these now to prevent really bad problems later on.
So glad that folks found this helpful! The best thing about being mindful about how you use your body when you play is that it will make you a better player in the long run. It's great to get an early start on this in your musical career.
I have some great interviews with violinists on my site, including Samantha George, Gary Kosloski, and Joseph Arnold, as well as with cellist and Alexander teacher Pedro de Alcantara!
Feel free to drop me an email with any questions via www.harmoniousbodies.com, and you can find out about my physical therapy practice in the DC metropolitan area.
Thanks to Diana for having so much insight into the "plight" of violinists. I shared this interview with my girlfriend, a licensed physical therapist who specializes in Women's Health, and she loved it. She's seen me perform with Barrage numerous times, and always worries about the weird positions I'm forcing my body into during the shows (and playing violin in general)!
I especially want to point out what Diana wrote about changing how violinists are taught. I LOVE that she suggested that "Violinists should be taught with a sense of perspective about life away from the violin, a sense of fun and play about music as well as “the serious stuff”, and healthy cooperation with others." I was lucky enough to realize this on my own throughout my years growing up studying classical violin, and was also fortunate enough to have pretty open-minded orchestra teachers who brought alternative styles into the orchestra repetoire, but it was not something I was ever taught by my classical teachers.
I know so many fantastic violinists who don't seem to enjoy the violin as something to just enjoy. They can't be satisfied unless they are playing a perfected masterpiece. It is my hope that more violinists come to the realization that playing the most out of tune improv solo over "Autumn Leaves" can be far more fun than playing Bach's Chaccone perfectly, even if it is not as impressive. To be impressive is fun, but to have fun does not require impressing anyone.
I agree, Jason, and I must say that I was a little surprised with Diana's answer there, about how we can change teaching. I expected her to immediately talk about mechanics! But her first advice to teachers was to teach balance in life, then to think about things like fingerings, etc. It's entirely appropriate. Over-practice, practicing with pain, practicing with stress...these are the things that lead to injury. A holistic approach, where violin practice is put into perspective, makes sense. Thanks, Diana!
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