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When It Hurts To Play

A Look Into Injuries Common Among Musicians

Links - My Injury - My Exercises - UnSilent Killer

There are few things more frightening for a musician than developing a chronic injury which makes music making difficult, painful, or impossible. Fortunately there has been a recent surge of investigation by the medical community to understand those injuries that are common among musicians. As a result, those of the medical and musical communities are discovering postures, grips, muscle stretching and strengthening exercises, and in certain cases, surgical techniques which help musicians play with less stress, pain, and injury. Clinics which specialize in the medicine for musicians are growing and spreading throughout the world.

In addition to the medical discoveries, attitudes are beginning to change about musically related injuries. Until recently, most professional musicians would hide their injuries, fearing that potential bands and booking agents (for all the same reasons as their counterparts in athletics) would shy away from musicians that were "injury prone". My personal experience lends me to believe that a minor adjustment in technique or a few conditioning and stretching exercises can make the difference between painful and painless playing (For the musician, that is. A performance which is painless to an audience still sadly requires a bit of effort).

My Injury

Before introducing some helpful references, let me share my own experiences. My first problem manifested itself as a weakness and occasional aching in the outside fingers (i.e. the small and ring fingers, as opposed to the inside fingers, the thumb and pointer finger). Concerned that I had a nerve entrapment, I made an appointment with a neurologist. Two days before my appointment, I saw my own doctor at the University clinic (someone quite familiar with sports medicine as he treats the members of the Notre Dame football team) about another matter and mentioned my plans to see the neurologist. After an exam, my doctor insisted that my problems were not nerve related and instead suggested some stretching and strengthening exercises. I canceled my appointment with the neurologist, saving a rather unpleasant experience and several hundred dollars, and within a week or two, saw noticeable improvement.

My exercises

Hand Stretch - Pointing UpThe exercises were simple. To stretch, I start by placing my palms and fingers in front of me, with my fingers pointing up. Then, slowly, while pressing my fingers together, I lower my hands towards my waist until I feel the muscles in my lower arms stretch. Note that stretching exercises should never be painful. Start slowly until greater flexibility is attained. I hold this position for a full 60 seconds first thing in the morning, and I repeat it 20 or so times during the day, some times for only 30 or 15 seconds, more frequently when I am playing or typing for long periods of time.

Hand Stretch - Pointing DownThe second stretching exercise is similar to the first. I place the back of my hands together in front of me near my waist, then bring them up slowly until my hands and arms form a 90 degree angle. I hold this for 60 seconds and repeat this exercise frequently throughout the day.

For strength I have a ball of putty that I squeeze with my fingers while reading, watching TV, etc. A tennis ball or racquet ball could be used as well.

The UnSilent Killer

Although not frequently mentioned in the musical injury literature, hearing loss due to exposure to loud sounds is in my opinion the most common and unnecessary of all musically related injuries. Most musicians spend countless hours exposed to sound at levels which, if exposed to for a period of time, are known to erode hearing. Unfortunately for many young musicians, it may take 10 to 20 years before the problem becomes noticeable, and so few precautions are taken until it is too late. The damage is permanent. We all know people who start to lose their hearing in their fifties, and are nearly deaf by their sixties. In most cases these people were exposed to elevated levels of sound on a daily basis. Certainly a traumatic experience for anyone, I could not begin to imagine how upsetting this would be to one who made music a daily part of his life.

It is also important to note that we often cannot trust our ears in judging the loudness of a sound. Short of causing immediate pain, loud sounds are often not judged to be loud unless there is distortion. That is, we are much more sensitive to distortion than the actual volume of a sound. In many cases, a low budget sound system which distorts at a very low volume is perceived to be louder than a high power sound system at a rock concert, which produces very loud sounds without distortion. Headphones are another example, since with very little power, they can impact directly on your eardrum with little distortion, and thus seem less loud than they actually are.

In addition, after a period of time of extensive exposure to loud sounds, our sensitivity threshold actually shifts, and thus the sound doesn't seem as noticeably loud. This effect is similar to (but not exactly the same as) the effect of not noticing one's own perfume an hour after it is applied.

The musician encounters many elevated sound sources: Percussive and brass instruments, pipe organs, amplified instruments (e.g. electric bass guitar), studio monitors, and of course our loud car and home stereos. This on top of the periodic noise sources encountered by most people, including car and airplane engine noise, construction work, dance clubs and surround-sound movie theaters.

There are several products which can reduce the damaging effects of noise, but I rely solely on the basic wax ear plug. Small and unnoticeable, they can reduce the level of sound that reaches the eardrum by up to 20 dB. I wear them whenever I am in the car, going to a dance club, hearing an amplified concert, performing on stage, or even practicing with others when percussive or amplified instruments are involved (both of which I play). In the car, with my earplugs in, I can turn up the stereo above my car engine without concern. Note that these earplugs tend to reduce the treble a bit more than the bass, so in the car I push up the treble a bit.

In summary, if you wish to enjoy your hearing for a good long time, taking precautions now will make a significant difference later.


The most extensive site that I've come across is the Music Injuries Web Page maintained by Paul Marxhausen. I encourage anyone who plays an instrument to look over the information at this site. I have only begun to study this information and will report here as to which resources I found most helpful.

Thus far I have read the first two books listed. The first, The Musician's Survival Manual: A Guide to Preventing a Treating Injuries in Instrumentalists, by Richard Norris, M.D., cannot be recommended more highly. I found incredibly informative and interesting, a must read for those new to the topic. In it, Dr. Norris discusses several common problems by describing the related anatomy, explaining clinical tests (which you can often try at home), and discussing treatment options. Also included are Appendicies listing Performing Arts Medical Clinics and an extensive suggested reading list.

The second, You Are Your Instrument by Julie Lyonn Lieberman, I found much less helpful, although comes highly recommended by some. Although there were sections devoted to the effects of stress and poor posture, the emphasis seemed to be more on the mental and emotive aspects of music making as opposed to the physiological. While a helpful tool for someone searching for a holistic approach to music making, and while there are sections on physical injuries, it lacked the depth found in The Musician's Survival Manual. The author is a musician, not a doctor, and as such tends to focus on what can be done to make music making more a more enjoyable experience. I did not get too much from the book.

Both were available from an inter-library loan program, so check there before rushing out to the bookstore.

Mail meAs always, corrections, suggestions, and comments are welcomed. Please email me at [email protected].

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When It Hurts to Play by Ken Laberteaux . Copyright 1996.
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