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Erika Burns

When a warning isn't enough...

March 29, 2011 at 11:54 PM

Today I read an article in the Strad magazine about tissue injuries. Naturally, this piqued my interest; I am in rehabilitation for such an injury. Interestingly, some medical experts are calling these injuries “maximum tissue exposure.” Whether a player has an existing injury that doesn't heal, doesn't rest enough between playing, or is getting to an age where it is harder for their tissue to recover, it is important to recognize that we have finite bodies.

Last summer, I wrote a blog post detailing my own struggles to recover from an injury I sustained four years ago.  I was frustrated, but hopeful that I would find an accurate diagnosis and recover. I didn't meet someone who knew how to treat my injury for another four months. My first quarter of the school year was miserable–later on, my teacher joked that we didn't want me to feel like a violinist leper anymore–I was constantly in pain and no one I worked with knew how to treat it. When I finally was able to start working with my current physical therapist, she found that my fascia was like cement and contorted out of position in various places around my body. With a mixture of fascia manipulation and Feldenkrais, I am starting to make a slow comeback. I went from playing five minutes or less a day for six months to 30 minutes in a month and a half. However, I still deal with my pain on a daily basis–but I can manage it as my body continues to improve. To me, there is no doubt that my tissue has reached “maximum exposure,” but I refuse to believe that I cannot recover. Yes, there is frustration, tears, and depression, but I can't give up. I dream of playing Bach, performing, and teaching in a program like El Sistema. 

In my readings, I have found so much information on preventative therapies–everyone needs to know this. I go to a school where injuries are common place. It is great that the Strad, Strings, and numerous books are stressing the need to play healthy. I don't think it has reached a big enough audience yet–and very few publications address what to do when you have an injury. Most refer to making a plan with your doctor/therapist and teacher.

That's not good enough.

Not many locations around this country have performing arts medical specialists. Even fewer music schools have on-staff therapists, Alexander technique/Feldenkrais specialists, or doctors who know how to treat musicians. This might seem like a luxury, but most musicians with injuries are left in the lurch. Some of us are lucky to have teachers who understand what it's like to recover from an injury. Still, getting a proper diagnosis and therefore the proper treatment can be a nightmare. I know people who had a case of tendinitis, rested, did physical therapy, and were playing a month later. I know others who, like myself, did all the above and nothing worked. Fascia injuries are often mistaken for other injuries like tendinitis or nerve impingements.

So what do we do? While venting about my earlier doctors makes me feel better, it doesn't help me heal. But I think there are a few things we can all do: first, we need to talk and share stories and treatment. I pass on the stretches I learned from my therapist to my fellow students. Secondly, learning relaxation techniques is a must. I am so self-critical that I often increase body's stress level. My muscles are in a state of perpetual tightness, which is the main cause of my pain. Thirdly, how often do we pay attention to our bodies? I know I am guilty of sequestering my awareness in my head. I would recommend looking into a method like Feldenkrais, which teaches you to use your body more efficiently.

The point is, WE need to be the literature on healing injuries. is a perfect place to come together and discuss. We also need to be advocates and communicate our experiences with the medical field, music schools, and students. Major injuries such as fascia pain interfere with all activities, not just music. Telling someone to give up the violin will not lead to healing (in fact, learning new music has caused me to recover faster); instead, we need to provide each other with support, encouragement, advice, and the beliefs that wellness and art can coexist--and that we can recover. 

From Charlie Caldwell
Posted on March 30, 2011 at 5:57 AM

Thank you so much for taking the time to write this.

From Diana Rumrill
Posted on March 30, 2011 at 1:21 PM

I couldn't agree more!

Run-of-the mill orthopedics and physical therapy is centered on the sports injury model. There's not a lot of general knowledge of what is involved in playing an instrument or singing, how to rehab from repetitive strain besides complete rest, and how to work with improving the overall use of the body (besides the dreaded word "posture") to change what got the person into the problem in the first place.

As many rehab MD's and PT's got into the field because of a sports and fitness interest, I don't necessarily blame them for their ignorance of these things. When I tell my physical therapy colleagues that I'm a violinist who has a specifically musician-focused PT practice, it often has never occurred to them that musicians get injured.

In the Washington, DC area, I see musicians for physical therapy, using principles from the Alexander Technique as well: .

The Performing Arts Medicine Association keeps a directory of their members around the world, and you can do a search for medical professionals in your area who specialize in musicians:

Best wishes for a steady recovery!

From Emily Liz
Posted on March 30, 2011 at 2:39 PM

Amen to this entry. Learning good posture, good habits, a pain-free way of playing... Those things are not luxuries. They're necessities. But too many teachers and players are totally unaware of these issues or say or imply things like "buck up."

From al ku
Posted on March 30, 2011 at 5:19 PM

 i think the blog is very well written and agree with other posters. time to get more proactive.

in addn, i think with the title, when a warning is not enough, another very important aspect worthy of discussion is how to prevent the injuries in the first place.

violin related injuries are usually different from sports injury in that the former is usually low speed, high rep type, not high speed, high load type.

in other words, violin related injuries tend not to happen,,"all of a sudden".  a violin related injury has given the player ample time to react. again and again.

so the question is: why is it so prevalent?   is it because the prodiginess inside each violinist just run amok?

what do violinists do with initial signs of trouble?   what are the signs to look for?  what circumstantial factors are there that prevent a musician from taking the initial signs seriously? etc, etc, etc

what i do with my kids in violin and golf is that whenever there is a slightest sign or feeling from them of any discomfort, i must be informed immediately.  i will evaluate the situation, exam them, palpate areas of discomfort and then make a decision to continue or to walk away from playing.  i always err on the side of safety because missing one day is much better than missing one week and the worst case of all, missing one life.

it is a tough call all the time, because my kids and i can look at wimps.  but looking back, i am glad we look like wimps than looking brave and doing harm.

when my kid plays the violin, as much as she does not like, i frequently spot check her by asking her in the midth of things intense where are the tight spot in the body.  i believe over the long term, since she knows i may spot check, she will learn to condition herself differently which will be to her own benefit. 

so wake up people,  take prevention more seriously. 


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