Musician-Related Injuries: 8 Ways to Avoid Them

An interview with a real physiotherapist

Guitarists with protesting wrists, and trumpet players with rattling teeth. Whatever your instrument is, continuously overworking your body soon catches up with you. So why wait until it actually needs treatment?, asks music physiotherapist Ida De Boer. Her first piece of advice is simple: “Take care of your body and prevent cumulative injury.” These are the kinds of injuries that creep up on you, and come in various forms. Below, Ida gives us a brief run down.

Trigger finger

Trigger finger might sound like something you want, but it’s anything but. Stenosing tenosynovitis (as it’s termed in the medical world) is a limiting injury where one of your fingers gets stuck in a bent position. This is caused when the sheath that surrounds the tendon gets inflamed and restricts the movement of the tendon, and therefore the movement of the finger.

There are a few musician-related injuries that come with some pretty catchy names. Satchmo’s Syndrome, for example, was named after the legendary trumpet player Louis Armstrong who suffered from a ruptured lip muscle. And another prime candidate for your next album title or djent project is frozen shoulder. This painful injury can restrict the movement of a musician to such an extreme extent that their role in the band might be reduced to just making the tea.

No pain, no gain

Like being an athlete, being a musician makes a lot of demands on your body. Some instruments have such an anti-ergonomic design that they might as well have been built for medieval-style torture, but still, you carry on, and you rehearse until you drop. No pain, no gain, right? Complaining about pain or cancelling shows because of physical problems is simply not done. You can’t let the fans or your bandmates down and you have to give your all on stage. Even so, it’s no secret that musician-related injuries exist, and if you’re not careful, making music can literally destroy your body. The majority of classical musicians endure physical pain as a rule, and since many are on the payroll with an orchestra, they are protected by the Health and Safety at Work act. But that’s not to say that they still don’t perform sitting on unforgiving metal folding chairs while the audience sits comfortably, nestled in red plush.

Check yourself before you wreck yourself

At 50 year old, Ida De Boer has been the physiotherapist for the Gelders orchestra in the Netherlands since 1998 and has been running her own physiotherapy practice for just as long. While the orchestra has since made cuts, she is still kept busy and since she started working with them, absenteeism is a rare occurrence. In the meantime, more and more rock, jazz, and pop musicians are stepping into her clinic in search of help, and it doesn’t matter what you play, the problems are all the same and almost always have something to do with overworking the musculoskeletal system.

Guitarist Leo Pennock is a regular at Ida’s practice. He and his Hagstrom guitar (the guitar models that he also lovingly restores) are inseparable. Having initially walked in with a problem with the joint of his left wrist, he’s now doing much better, but pops in every now and then for a checkup so Ida can keep an eye on Leo’s muscular tension and muscle control.

“I tailor the treatment to each individual and always ask any patient to either bring their instrument in with them or make a short video of themselves playing. I then analyse their playing posture and assess their body movements before adjusting a treatment plan to meet their needs. When assessing body movement, I test the pattern of contractions of specific muscle groups and pinpoint what’s used most frequently, and ask questions like, why is the grip of the left hand more strained? Is the brain communicating efficiently with the muscles?” Ida refers to this process of analysis as taking a look under the bonnet to find out her patient’s story to find out why they are experiencing pain or discomfort. “As soon as you know why the problem has occurred in the first place, you can usually find the solution.”

Grip

Leo Pennock developed his injury after a combination of playing the guitar, steering a motorcycle and riding his bicycle. Besides discomfort in his wrist, he experienced pain in the extensor muscles of his fingers. “Straining any part of the body is always cumulative,” says Ida.

The narrow neck of Leo’s guitar was perfect, so no change was needed there, but under Ida’s advice, Leo replaced the handlebars of his bicycle and raised the handlebars of his motorcycle to give his wrist some relief. However, while a thinner-than-average guitar neck is ideal for Leo, it’s not necessarily going to be perfect for a punk guitarist with tennis elbow, which is why there’s no one-size-fits all treatment for musicians in pain.

“I had a patient come in who had shovel-sized hands but played a bass guitar with a very thin neck. The solution for him was to find a bass with a neck that offered a wider grip, so that he could make a more relaxed fist while playing, instead of a small and tight fist.”

“In the heat of the moment, many guitarists and bassists have a habit of gripping the neck with their thumb, but this is never necessary. The thumb should only be used to counter the pressure that your fingers are applying to the strings and fretboard. It’s an unconscious reflex since the nervous system is more set up to form a fist than to control each finger individually. So, when playing more complex parts, this reflex happens naturally and before you can even think about it. If you’re asking your body to do something that it finds difficult then your brain will pull out all the stops. This is why musicians tend to do all sorts of weird things with their pelvis and their jaw muscles when fully concentrating on what they’re doing. It’s basically unconscious compensation.”

Armor

”Yesterday I had a bass guitarist with an inflamed tendon in the left ring finger. I see this a lot. Tendons will start to protest after prolonged strain or when pushed to the limits. The musician told me that she’s just started playing in two bands and has been playing much more than usual.” So, is the best advice in situations like this simple: play less? “That’s the advice that any GP might give, but I actually don’t agree. Instead, I offer injured musicians some advice regarding technique and offer them some tactical tips.” So a thirteen year old drummer with pain in his achilles heel was advised to try using podo insoles. “His achilles tendon sat a little strangely beneath his calf because of his flat feet.”

Saxophonists with neck problems are immediately advised to swap their saxophone cord for a harness that actually distributes the weight of their instrument across the shoulders. “These thin straps pull on the neck and cause it to bend strangely, hindering saxophone players while they play. While the solution isn’t quite as ‘sexy’, using a harness that places the weight of the instrument on the shoulders is immediately effective.”

Hyper

There are many people in the music world with hyperfocus and hypermobility, and while many of them achieve great things, they are more prone to developing injuries. For musicians with hyperfocus, no mountain is ever too high and they often keep pushing themselves to practise for another hour, and then another, because it will ‘make them better’. Ida: “That’s a tricky point. In music, you can always improve.” Hypermobile musicians, on the other hand, have extra-mobile joints and are able to perform incredible feats with their instruments. “Hypermobile performers are also often found in the circus. While they can do amazing things, their muscles are put under extreme strain to keep everything stable.” Basically, hyper-people don’t know where the boundaries are. Ida: “I can get them to set some safer boundaries. For example, set an alarm if you know you’re going to go too far, always schedule in some breaks, and give any injuries a chance to recover.”

The biggest problem is when musicians only seek help when their playing starts to suffer. Together with one of her colleagues, Ida has been giving professional health courses to first year music students to help nip this attitude in the bud. “Our first question is always: have you ever had any musician-related injuries and at what point do you call for help? If you have recurring pain that lasts for at least three weeks, or pain when exerting maximum strain, then get it looked at. Why wait until you can’t go on? The way back is always twice as hard as the way there. To be blunt, waiting for six months to ask for help will amount to a year’s worth of recovery time. And swallowing endless amounts of painkillers is never recommended, since you’re simply putting off the inevitable.” Ida advises that the best way to prevent injury is to retain balance. “Poor stamina, bad sleeping patterns and eating habits can quickly lead to overload. If you want to be more resilient, then work on your general condition and self-care habits.” – and heed the wise words of a highly experienced physiotherapist!

Flow

Being a musician is one of the greatest pursuits in the world, and according to the physiotherapists that treat those musicians, this is exactly why it’s such an injury-prone profession. Musicians can get caught up in the flow. They play for kicks; for that euphoric feeling where you seem to sprout wings and gain momentum – to the point where you feel like anything is possible. “Flow improves coordination and does something to the brain so that you no longer feel your body, time stands still, and you’re transported to another dimension. You don’t feel any pain – that won’t come until the next day.” This feeling could be compared to the addictive ‘runner’s high’ and those who experience it are left wanting more and more of it, increasing the chance of complete overload.

Be kind to yourself

Luckily, most injuries do heal, as long as you maintain a positive approach. “How you think about your injury,” says Ida, “has a big impact on the healing process. For that reason, I try to offer guidance rather than diagnosis. For example, I won’t just announce that someone has tennis elbow and then watch the distressed look on the face of a musician who suddenly sees the end of their career.” So, stress has its part to play? “I’ve never met a musician who is entirely stress-free. Performing for a living is stressful. Many vocalists and musicians often hold their breath or breathe shallowly when performing and this is in fact a stress response. In any situation, always try to breathe normally. A little bit of nerves can actually have a positive effect on the performance, but if it’s allowed to turn into stress, then it can be a hindrance. And, if your stress is a result of a negative way of thinking, then try to notice when it happens and take a different path in your head. Speak to yourself with a kind voice. It might also be wise to seek the help of a therapist”

The Problem of Brass

Brass musicians have their own unique set of problems. Besides neck, shoulder, arm, and finger injuries, brass musicians also risk suffering from mouth and facial muscle injuries. Ida treats many musicians with rattling teeth, where their teeth are literally shaken loose by the pressure and vibration of the mouthpiece. Since this can shift the position of the teeth, it can cause problems. There was one particular case of focal dystonia that Ida remembers well, where random mouth muscle spasms made the musician’s embouchure impossible and unfortunately proved impossible to treat. “With this form of focal dystonia, the muscles controlling the lips involuntarily contract, so that the musician is no longer able to produce pure notes.” The trumpeter in question initially tried to solve this problem by using larger and larger mouthpieces before they were finally forced to give in.