Musicians' Health Matters: Discussing Music-Related Injuries and Prevention Strategies 🩺

As we all know, playing music can be a physically demanding activity. Whether it's from hours of practice, or performances, our bodies can take a toll. I wanted to start a conversation about the topic of music-related injuries, and invite all musicians to share their experiences and advice on how to prevent and treat them.

Have you ever experienced pain or injury as a result of playing an instrument or singing? How did you handle it? What steps did you take to prevent it from happening again?

I think it's important for us to have open and honest discussions about these issues, so we can all learn from each other and take better care of ourselves as musicians.

So please, share your stories and let's start a conversation!

43 replies

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    • Art Historian, Musculoskeletal Radiologist, Former Harpsichordist
    • MichaelP
    • 3 yrs ago
    • Reported - view

    What do you think about this simplified view about piano technique, which offers some premises in the interest of allowing technique to be built around injury prevention?

    • Ortmann’s two seminal books seem to establish that the performer has only a few mechanical effects at his disposal: the velocity with which the key is depressed, how long the key is held down, and what is done with the pedals
    • All the various desciptions of techniques devoted to eliciting specific characters of sound and the elaborate gestures needed to produce them are actually just maneuvers to control the velocity with which the key is depressed, timing of its depression and release. There is no magic.
    • The various timbral qualities supposedly elicited by technique also result from only the velocity with which a key is depressed (and interaction with other events like concurrent notes being played, pedal effects, and thumping of the key or other mechanical components against felt). The timbre of any note which is imagined to be controlled by some technical finesse (ā€œbrighterā€, ā€œdarkerā€, ā€œsingingā€) is also a consequence only of key velocity (and ambient sound environment). The timbral changes are the consequence of the elastic or compressive properties of the hammer felt, which have a non-linear relation to the force with which it strike the string, hence eliciting more or fewer upper partials.

    None of this minimizes the finesse and skill of the pianist in creating music, but thinking in this way might facilitate development of a safer, simpler technique.

    Is this perspective controversial?

      • PViseskul
      • 3 yrs ago
      • Reported - view

      Michael I feel that this kind of view that boils everything down to plain and dry physics of the piano really doesn't help as it ignores human physiology and also does not describe in anyway what/how one should do to avoid injuries at the piano.

      • Art Historian, Musculoskeletal Radiologist, Former Harpsichordist
      • MichaelP
      • 3 yrs ago
      • Reported - view

      Priya Viseskul yeah, that view doesn’t deal with the fundamental, practical problem of ā€œhow should one play this contraptionā€.

      • Cynthia_Crawford
      • 2 days ago
      • Reported - view

       Thomas Mark has written a book called "What Every Pianist Needs to Know About the Body", with an accompanying video. It appears to be out of print but still available. I found it a bit dull but   that is just the manner of approach. The actual ideas are excellent.

      https://www.scribd.com/document/859188973/What-Every-Pianist-Needs-to-Know-About-the-Body-Premium-Download

      I am not sure the video is still available-too bad as it is a good illustration of the ideas...sometimes called "body mapping". 

    • ALICE.1
    • 3 yrs ago
    • Reported - view

    I had left hand wrist pain due to 1. not understanding how to release tension, 2. collapsed knuckle bridge (I don't have strength in these muscles) 3. my LH finger 5 and 2 second knuckle also collapsed for some reason - so I overused wrist to compensate these issues. I finally found a teacher who pointed out these issues, and now I'm working on slowly developing these muscles and finger strength and proactively working on releasing tension when I practice.

     

    My new teacher constantly put her hands on my shoulder to remind me to relax my shoulder. I often tense up my shoulders as I am engaged in practice. I put a mirror next to myself to watch my movement now. 

     

    I'm open to hear your feedback if you have suggestions!

    • Mom, fitness instructor, lover of music
    • Michelle_Russell
    • 3 yrs ago
    • Reported - view

    I'm dropping this here as I just found it: https://www.musicandhealth.co.uk/health.html

    I haven't looked at the site thoroughly, but it looks like there may be some useful information on it. (I was looking for information on something my son's teacher just told him regarding what a professor in her PhD program is having students do to 'correct' high wrists while playing. I didn't find what I was looking for, but did find this interesting site!)

      • Art Historian, Musculoskeletal Radiologist, Former Harpsichordist
      • MichaelP
      • 3 yrs ago
      • Reported - view

      Michelle R that is a great link with lots of promising references.

    • Art Historian, Musculoskeletal Radiologist, Former Harpsichordist
    • MichaelP
    • 3 yrs ago
    • Reported - view

    Check out this link to beautifully animated presentations of Chopin’s method of playing, from a specialist in biomechanics of piano playing with interest in injury prevention.

    https://youtu.be/ctWUmDLATJw

    • Art Historian, Musculoskeletal Radiologist, Former Harpsichordist
    • MichaelP
    • 3 yrs ago
    • Reported - view

    Mini textbook online that has some excellent information, by a specialist surgeon:

    https://www.musicianshandandwrist.com

      • pianophile
      • marina
      • 3 yrs ago
      • Reported - view

      Michael hi Michael. Just checking in to see how you are getting on in your recovery? I hope there has been some improvement and you are feeling more hopeful of a complete recovery. Best, marina

      • Art Historian, Musculoskeletal Radiologist, Former Harpsichordist
      • MichaelP
      • 3 yrs ago
      • Reported - view

      marina How kind of you to ask! It has be nearly a month since I shut the lid on my piano, and I am slowly beginning to improve. At some point I may try to play again with limitations. But I’m pretty sure now that I should have surgery for carpal tunnel release. I’m going to look for interventional radiologists who use device for that procedure under ultrasound guidance. (I’ll attach a link).  Much more research to do. 

      How are you doing with Rae’s course? Is it the answer?

      https://sonexhealth.com/physicians/carpal-tunnel-release-with-ultrasound-guidance/

      • pianophile
      • marina
      • 3 yrs ago
      • Reported - view

      Michael I’m sorry to hear it’s got to that point - I know I would be devastated if it were me - but it seems you have all the research ability you need, and maybe some medical connections, to make a good decision on the way forward. Are you able to play with one hand? Rae’s course is excellent. Very well explained and illustrated. You might consider trying it with your good hand to give you a head start. 

      I hope that during this transition you are able to keep music alive for yourself with inspirational recordings, readings, and live performances. Perhaps you can even experiment with memorising away from the keyboard as preparation for your recovery…..

      In any case I wish you the very best as I’m sure your other friends here do. Keep us posted. :-)

    • Angela_Fogg
    • 3 yrs ago
    • Reported - view

    I have just read through this thread and it is clear this is such a big topic and so essential for us all. My teacher for several years was Carola Grindea who had studied with Tobias Matthay. Matthay was criticised for advocating what people thought was over relaxation but considering that he was one of the first to think about technique in this way over 100 years ago it was probably proportional to the lack of investigation or joined up thinking at that time on the topic. In the 1980s Carola founded the European Piano Teachers Association with one of the aims being to teach teachers how to teach, avoiding technical problems caused by tension. She also founded ISSTIP, the International Society for the Study of Tension in Society. This drew together therapists, medical and musical practitioners and led to BAPAM, a degree in performing arts medicine in the UK. This area of study has come along way with ever improving technology proving. The other people you list above have also had this benefit and we must know more scientifically proven information than ever before. As is many areas of life I suppose!

    I think Penelope Roskell explains technique so clearly, in a way workable for everyone- her course is definitely worth looking out and following.

     I have small hands and have always had to think particularly about big chords/octaves. One thing I think I have learned is not to ā€˜end game’ simply getting through a passage regardless of how I do it. Pain is a sign something is not right, it mustn’t be ignored or put up with. But I think also don’t expect things to happen quickly. You can make progress but be content with tiny steps that mean you work with your body and with the instrument rather than setting the two against each other. 

    It is good you have been able to do so much research Michael and I hope you find something that works for you very soon.

      • Art Historian, Musculoskeletal Radiologist, Former Harpsichordist
      • MichaelP
      • 3 yrs ago
      • Reported - view

      Angela Fogg Thanks for asking after me and for sharing some some of your own experiences and resources. Your insight into the dangers of going for the ā€œend gameā€ at any cost is valuable for me to hear, because I am entirely guilty of that. When I look at the videos I submitted last month, I don’t see anything that strikes me as risky from the looks of my technique; but I know that under the surface it is achieved with  an excess of muscle tension and lack of coordination. After I sort out my current issues, as you suggest it’s time for me to pause and relearn technique in baby steps.

      Since the onset of significant symptoms, I have abandoned piano playing entirely, shutting the lid on the piano to avoid all temptation. Gradually over the last month my symptoms have improved to levels fully tolerable for daily activities, but I know from experience that playing the piano is the main cause. I’ve decided not to attempt further playing until I can consult with some medical experts, and self-educate about the various approaches (mostly involving diferent methods of carpal tunnel surgery) to management. I’m sure my symptoms are largely attributed to median nerve compression at the level of the carpal tunnel; but there is also some contribution to ulnar nerve impingement, and the whole forearm from elbow to hand is involved. The symptoms when severe have impeded normal daily use of the arm and hand—so that is why I won’t take any further risks until I have settled on a course of action.

      I also note that medical/surgical treatment tends to proceed blindly and empirically (based on exam, history, and probabilities)—which works fine when the bar for successful cure is lower than that required for the likes of a musician. I’ve seen this go wrong, so I intend to get an MRI of the wrist for a full assessment of any anatomic/pathologic contributing factors before any surgical solution is contemplated.

      One thing I’m learning while working through the recent medical literature, is that there is barely any attention to the assessment of the particular needs of musicians. Studies of alternative surgical interventions to carpal tunnel release do not evaluate for potential loss of finger dexterity or of the high level of upper extremity functionality demanded of a musician.  There is a fairly low bar to ā€œsuccessā€, graded on the relief of pain and numbness, and to the maintenance of strength in the intrinsic muscles of the hand.

      I have found one updated, specialised medical textbook, which I have ordered, Ian Winspur’s The Musican’s Hand: A Clinical Guide (2nd ed).

      https://www.amazon.com/gp/product/1909836818/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

      I’m also identifying the most promising surgical techniques, and surgical experts who are likely capable and inclined to take the special needs of musicians into account.

      I don’t want to tax our tonebase colleagues by making these posts all about me! But if there is interest, I’ll share what I learn about the most up-to-date medical/surgical approaches to management of upper extremity repetative use injuries in pianists.

    • Art Historian, Musculoskeletal Radiologist, Former Harpsichordist
    • MichaelP
    • 3 yrs ago
    • Reported - view

    A separate thread now addresses How to Deal with Thumb Arthritis. 

      • Cynthia_Crawford
      • 2 days ago
      • Reported - view

       Where is the thumb arthritis thread? Just what I am dealing with! Thanks. 

    • Concert Pianist • Piano Researcher • Piano Educator
    • Emma_Leiuman
    • 3 days ago
    • Reported - view

    This has become one of the central questions in my own work.

    Over the years, I've come to wonder whether many playing-related injuries begin much earlier than we think. By the time pain appears, the body has often been compensating for a long time.

    Physical tension certainly matters. Misaligned wrist or elbow motion, static positions, and excessive muscular effort can all contribute to injury. But I've also found another source that is easier to overlook: mental tension. When the musical image is unclear—when we don't yet internally hear every note, direction of the sound, harmony, dynamics, voicing, distance between the notes, phrasing, form, inner pulse etc—the body often starts searching for solutions physically. That search can become surprisingly demanding.

    Looking back, I don't think my greatest improvements came from learning how to relax. They came from understanding why I was becoming tense in the first place. As the music became clearer in my mind, many unnecessary movements simply disappeared, and the hands no longer felt the need to work so hard.

    I'm curious whether others have noticed a similar connection between the clarity of their musical thinking and the physical ease of their playing. It isn't a relationship we discuss very often, but I suspect it's more significant than we realise.

    • Stephanie_Reuer
    • 3 days ago
    • Reported - view

    Folks have been mentioning Peabody’s Performing Musicians’ Clinic, which is a part of Johns Hopkins. Peabody is also under the JHU umbrella.

    I have been a patient there for a bit over a year and it is absolutely terrific. The leader, Dr. Serap Gray is, herself, a classical guitarist and deeply understands musicians and the physical challenges associated with playing at a high level. I HIGHLY recommend them. The facilities are quite quaint, but the knowledge and approach is world class.

    • Concert Pianist • Piano Researcher • Piano Educator
    • Emma_Leiuman
    • 8 hrs ago
    • Reported - view
     said:
    How did you handle it? What steps did you take to prevent it from happening again?

    I wonder whether we sometimes assume the body is the origin of the problem, when in some cases it may simply be expressing a deeper mismatch between the musical intention and the way we're trying to realize it.

    In my experience, many injuries are discussed in terms of muscles, tendons, posture, or technique. Those are certainly important. But I've often wondered whether they are always the starting point.

    Sometimes the body seems to be working extraordinarily hard to solve a musical problem that hasn't yet been solved mentally. If the sound quality, direction, phrasing, or movement implied by the score isn't fully understood, the hands may compensate by adding effort. From the outside, it looks like a physical problem, but perhaps the physical strain is only the visible symptom.

    It makes me curious whether anyone has noticed that certain passages become physically easier - not because the fingers became stronger, but because something in the musical understanding suddenly became clearer.

Content aside

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