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Musician’s Injuries

String players, like athletes, can easily hurt themselves at the instrument. Not because the instrument has sharp edges or a tendency to fall onto us, but rather because we tend to push ourselves to the limit and beyond (that’s one sure way to find where the limit is!). Usually, injuries come from an excess of enthusiasm: playing too long without a break, starting too suddenly without a warmup, trying too hard, excessive tension etc.

Sometimes a musician’s injury can be a sudden, “traumatic” event: this normally occurs we start playing at full intensity without warming up enough. But more frequently, musicians’ injuries are “chronic” – they start as an occasional annoying pain or dysfunction, and gradually get worse and more permanent as we continue to ignore them until ultimately we have pain 24/7 (even when away from the instrument) and cannot play at all. These types of “slow-onset” damage are called “cumulative (micro)trauma” or “repetitive strain” injuries.

Any cellist can easily and deliberately give themselves a “tendinitis” by simply overdoing it. It only requires practicing, over and over, without any breaks, a very difficult or uncomfortable passage, preferably loudly and at high speed, and then ignoring the increasingly urgent alarm bells ringing in your body. It doesn’t even necessarily have to be a particularly difficult passage. In fact, even the easiest, most banal movement can become “dangerous” if repeated enough times without rest.

Injuries arrive when we ignore our bodies’ messages. Pain or dysfunction is our bodies’ way of saying that we are not treating it well: that we are either doing something wrong or just simply overdoing it (doing too much). Normally we pay attention to these messages and thus know when to stop, but sometimes we either can’t stop (the show must go on) or we don’t want to stop (a very hard piece to learn, too little time to learn it, an excess of motivation etc) and we thus just ignore this feedback. This is risky behaviour, and the price that we pay for it can be very high.

Hard-workers suffer much more playing injuries than more relaxed, easy-going, laid-back ones. Every musician – every person in fact – should read “In Praise of Idleness” by Bertrand Russel. He wrote it in 1935 but it has lost none of its relevance in the meantime. The book could also have been called Ā “In Praise of Relaxation/ Slowing-Down/Patience/Reflection/Acceptance etc. A little bit of all that can not only help us to avoid injuries but brings many other advantages as well.

In order to avoid injuries, preparation is everything. Some words of preventive advice:

For tension reduction and bodily awareness, Alexander Technique, Feldenkreis, yoga, and many other mind-body schools are excellent complements to instrumental practice. Some people not only cure their chronic injuries but also improve their playing greatly by studying and practicing these disciplines.

Athletes are carefully monitored and looked after by sports medicine specialists. It is however only relatively recently that musicians are able to benefit from a similar level of care, thanks largely to the pioneering work of devoted music-and-arts-loving doctors and healthcare professionals. Now, not only have specialist clinics been set up for musicians, but also a considerable number of books have been published, in many different languages, about the prevention and treatment of musicians’ injuries.

HEARING PROBLEMS

The noise level inside a symphony orchestra – or in an amplified rock band – can be comparable to standing close to a large airplane at takeoff. Having oboes and piccolos playing nearby is like having a dentist drilling inside your ear, fortissimo trombones are the equivalent of working in a steel smelter and various percussion effects are comparable to the noise of a war zone. Composers (especially modern ones) love these powerful effects: these are potent toys. An orchestra playing fff is bound to impress an audience, and it is no doubt for this same reason that rock bands (especially the worst ones) usually put the volume up very loud.

Even when we are not sitting directly in front of piccolos, oboes, brass, or percussion, orchestral musicians run a serious risk of long-term hearing damage. But this is not the only noise-induced health problem that we can suffer: excessive loudness is very hard on our nervous system in general. We could consider it as a type of sensory overload, causing tiredness, irritability, and increased tension. A sure solution to protect our hearing (and our nervous system) is to play with special ā€œmusicians earplugsā€ but the huge dynamic range of symphony orchestra music poses a unique problem for the use of earplugs. When the music goes very soft we may not be able to hear ourselves well enough to have the necessary fine control of intonation, sound quality and volume. For this reason, those earplugs that can easily be semi-removed (loosened) from the ear canal (for the pp passages) without falling out, are preferable to the custom-made plugs that canā€™t. This requires a certain earplug choreography: we need to remember when to loosen them, and when to push them in extra hard. In a concert situation this is very easy to forget, and we may find ourselves playing a delicate pp passage while half deaf, or with our plugs loose just when the dB level goes through the roof. Perhaps we will need to write little markings in the part, just like for the mute: “plugs in” and “plugs out”!

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Let’s now look at some case studies: of individual musicians or of typical individual cellists’ “injuries”.

SCHUMANN

The young Robert Schumann was first and foremost a pianist until he damaged his little finger irreparably in one monumental “binge-practice” session. He wrote in his diary about that fateful practice session and its consequences. From his diary entries, we can see that his errors were absolutely typical of musicians in any epoch: he practiced obsessively (no breaks), during many hours, and with increasing frustration (= tension) a particularly difficult piece (his own Toccata in C). In spite of increasing pain, numbness, and dysfunction in his little finger, he continued relentlessly, increasing his efforts as his hand was more and more unable to cope and only stopping when he was no longer able to play at all. He then spent several weeks in a drunken daze as he came to terms with the consequences of his actions.

Although at the time it was certainly a personal tragedy for Schumann, for the rest of humanity his injury has been a blessing, as he was then obliged to turn all of his creative genius to composing!

THE CELLIST’S SHOULDERS

Although definitely appropriate in some exceptional situations requiring additional engagement, raising the shoulders creates (and requires) muscular tension and as a general rule should be avoided. Keeping our shoulders low, at the cello and in normal life, does not however mean letting them collapse: we need muscle tone and postural alertness, but what we donā€™t need is the permanent state of tension, alarm, hyper-alertness and hyper-engagement associated with permanently elevated shoulders.

A significant number of professional cellists have an early end to their playing career because of cumulative trauma damage (repetitive strain injury) to their shoulders. This tends to affect most often the right shoulder, which is not surprising when we think about just how many bowstrokes we do in our cellistic lifetime. Playing with a permanently elevated right shoulder contributes to this. Maurice Marechal had to stop playing definitively in his 60’s because of this problem.