Finger pain in young violinist

November 10, 2020, 9:09 PM · Hi all,

My son has been complaining of finger pain recently, I believe starting with violin but now also when he plays piano. The pain has shifted some - it was the pinkies, then wrist, then thumb. He's only 7 and he generally practices an average of 30-45 on each instrument daily. I don't know exactly what set this off but he's been playing a lot of Schradieck which can be taxing, and I've noticed some tension in his left hand. So it could be overuse with some bad habits. I've discussed with his teacher (who is fully remote) and I'm working with my son very carefully when practicing - watching his posture, his hand and arm movements, his thumb. We've also tried more breaks and some stretching during the breaks. We've had some sporadic improvement but in general I'm frustrated not being able to pinpoint anything. I wonder if he needs to take a practice break. I would appreciate any thoughts particularly if anyone has experienced something like this.

Thanks.

Gabe

Replies (29)

November 10, 2020, 10:01 PM · I would certainly insist on a practice break, but I would also recommend that you have him seen by his pediatrician, and if need be, have him evaluated by an orthopedic surgeon. If he's got some kind of overuse injury, he needs rest, possibly physical therapy, and careful correction of his technique to ensure this doesn't reoccur.
November 10, 2020, 10:29 PM · Have a luthier check his violin for proper set-up. A violin with even slightly too high action (the distance of the strings from the fingerboard) can cause hand injuries.
November 11, 2020, 1:15 AM · I agree with Lydia. It is concerning to think of a possible overuse injury in a child so young who is not practicing excessively.
November 11, 2020, 2:16 AM · He have to rest for some days.. than he must plays with minimun tension. Also use a good ointment
November 11, 2020, 5:12 AM · Definitely have your son checked by a pediatrician and an orthopedist. And I agree with George about making sure the violin is set up properly but there's very little to be done about the piano. I would suggest having your son checked by a physical therapist, especially one who specializes in musical injuries if one is available, or at least one who specializes in sports injuries.

The amount of practicing your son is doing is not excessive so it's time to consult with medical professionals especially those who specialize in the body's mechanics and motion.

November 11, 2020, 8:14 AM · Schradieck should not be fatiguing. If it is, there is a major technical issue that needs to be addressed.
November 11, 2020, 8:29 AM · Thanks for everyone's responses. I will look into everything!

Lydia on the Schradieck I was thinking especially of the stretches, e.g. fourth finger reaching to B in first position on the D string. Thinking maybe he did too much of that. Any thoughts on that?

November 11, 2020, 10:10 AM · The most important part of Schradieck is the first two pages. Stretches can be done later, especially for such a young child. Schradieck should teach us primarily to articulate without tension, and without that goal in mind, you can get into trouble. I don't know how long is being spent on it, but I wouldn't recommend more than 5 minutes per day at this point, and you may just want to cut it entirely until this pain subsides.
November 11, 2020, 1:31 PM · As a violin maker, I would agree with the set-up suggestion, but also, as a former Pediatric Nurse and a violin maker, is the instrument too big? Many teachers want larger instruments for better sound, often sooner than the children are ready physically.
November 11, 2020, 1:49 PM · Most teachers that I know, certainly including myself, prefer to keep children on smaller instruments as long as possible. I have had more than one conversation with a parent who was eager to advance their child to a larger size sooner than I thought was wise.
November 11, 2020, 1:52 PM · I don't think that it's advisable for small children to practice extensions unless they're advanced enough that their repertoire requires extensions.

Schradieck, first four pages are where routine velocity exercises should be focused. Some teachers will assign much of the rest of the book, though; I did most of op. 1 book 1 as a child.

How much Schradieck is his teacher assigning daily?

November 11, 2020, 1:58 PM · Thanks everyone. To recent comments and questions:

He's been spending a lot of his time on Schradieck, not a scheduled amount per day but a large focus. He spent a lot of time just on #1 and he skipped the extensions for a while. But when he started doing them he seemed to have a very easy time - much easier than me! Perhaps it was too much or too much on top of some hidden issues.

Violin size is definitely not a problem, but a good point. If anything it might be slightly small for him.

November 11, 2020, 4:13 PM · A young child (or anyone for that matter) should not be injuring themselves when playing. Period.

You should heed the advice of everyone in this thread and stop practicing until you get him checked out and cleared by a doctor.

November 11, 2020, 5:16 PM · Is the piano also full-size ? Piano can be even more stressful on the hand as violin. Some electric keyboards have narrow keys, but down-sized real pianos are uncommon.
November 11, 2020, 6:36 PM · Paul, thanks, I will.

Joel, yes the piano is full sized. His piano teacher is very focused on ergonomics so I don't think that's the trigger.

Edited: November 11, 2020, 6:59 PM · "Schradieck should not be fatiguing" but at some point it almost has to be, especially if you're not acclimated to it. Hearing that the youngster is "spending a lot of his time on Schradieck ... a large focus" suggests to me that he's overdoing it. Yes the pain may be caused by some underpinning issue but an exercise like Schradieck can magnify those greatly.

A seven-year-old isn't going to destroy his performing career by laying off for a couple of weeks, but a serious repetitive strain injury could easily do that.

In the meantime he could learn a little theory or watch videos on left hand technique such as the one by Nathan Cole on "minimum violin pressure."

https://www.youtube.com/watch?v=SC4oO9l8P-8

My daughter (plays cello) had pain in her right thumb base joint. Taking a couple of weeks off didn't help so we got help from a physical therapist in Richmond who specializes in upper extremities and who has experience treating musicians. Her name is Brenda Jackson and she was recommended to us by Susanna Klein. Our visits were online. The pain didn't go away immediately but it's gradually getting better. However, the teacher also backed off (I'd say by about half) on exercises that involve a lot of stressful right-hand work.

Edited: November 12, 2020, 7:27 AM · I would also consider that he may have a non-playing-related medical issue as well. While unlikely, kids can get a variety of usually autoimmune conditions, as well as tissue, muscle, and joint conditions that could cause what you are seeing. I would want to rule those out before assuming it is from overuse or playing. Can you describe more what he means by finger pain?
November 11, 2020, 9:04 PM · Paul, I totally agree - I want to fix this now and time off may be a big part of that. Your other suggestions also sound great. I appreciate the recommendation and may well contact her too. Thanks!

Susan, that sounds ... very bad. But it's not something I considered so thanks for bringing this to my attention. I can't give you a great description because he didn't give me a great description. I believe it started with the left pinky, then both pinkies, then other spots. Today I tried to do some very basic things with him. First we tried different setups without playing, just holding the violin. He found one preferred one but said there was a small amount of neck pain (I checked his posture and it seemed very good, these were pretty quick tests so no real strain). Then I asked him to "play" a couple bars without the violin - make the motions with arms and fingers and sing the notes. Again he said there was a small amount of pain. So it's sometimes in the fingers, wrist, thumb or neck, and apparently very easily triggered. How would you recommend approaching ruling out (or in) these medical issues?

November 11, 2020, 9:15 PM · It sounds like you have reached the limits of your expertise, and it's time to schedule a doctor visit.
November 11, 2020, 9:50 PM · Christian, yes that is the only thing that's clear at this point.
Edited: November 11, 2020, 10:23 PM · The great thing about the physical therapist is that she knew what kinds of questions to ask to pinpoint the specific muscles that were the issue.

Sympathetic pain between the two hands is not unusual, from what I've read (which was probably some crappy self-help paperback that I bought in an airport).

November 11, 2020, 10:42 PM · Start with your pediatrician. They'll refer you for further testing and followup, if necessary -- Within the limits of what your health insurance will cover, anyway. (They may need to draw blood if they wonder if juvenile arthritis or other autoimmune is a possibility, for example.)

I would not start with a physical therapist. They are not qualified to make a medical diagnosis, which is what you need in this case.

Edited: November 12, 2020, 6:36 AM · Please follow Lydia's advice ASAP. And just stop playing completely until you understand what is going on. Whatever it is, playing can only make it worse.
Edited: November 12, 2020, 7:23 AM · Lydia is correct; in most insurance plans you need a referral from the physician to get coverage for physical therapy anyway. That is what we did with our daughter. The first referral was to an "sports-medicine doctor" (an orthopedic surgeon) whose treatment regimen consisted of wearing a brace. Total waste of time. The man had no experience with musicians. Then Susanna recommended Brenda, and the problem is not solved yet but we've seen progress. Something that the pediatrician helped us appreciate is that "growing pains" are real. They have, in my cases, well-defined organic causes. That wasn't the thumb, though. That was the knee.
Edited: November 12, 2020, 3:39 PM · Is the action of the piano ok? If it is a heavy action, or otherwise not ok, then that is something I suggest may need to be factored into the problem.
Edited: November 12, 2020, 7:08 PM · As somebody who suffers both from RSI of the left wrist and also arthritis of some finger joints I can say that you should stop now for a week or two and see if the pain goes away. That will also help the doctor to determine what the problem might be. It could be nothing to do with the violin or piano but you will not know until you stop playing.
November 12, 2020, 10:24 PM · My money is on the violin being the culprit, but just out of curiosity has your son recently started playing pieces on the piano with octaves in the left hand?
November 13, 2020, 8:50 AM · Trevor, I think the action on the piano is ok but I could get a second opinion to make sure.

Paul, no left hand octaves - his hand's not big enough and that would be a huge stretch. He's recently started a piece with broken octaves in the right hand but he's playing that section using a swing of the hand, and also under tempo for now. Doesn't seem like that would be problematic.

November 13, 2020, 9:46 AM · Gabriel I agree. A seven-year-old rarely does octaves but sometimes teachers like to push it and then you can have problems. The method books know better than to write octaves into the earliest books but sometimes a child will find other music to mess around with -- at this time of year it might be Christmas tunes, for example, and lots of "easy piano" arrangements do include left-hand octaves.


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