Larry Krantz Flute Pages: Don't Play With Pain - Flute
by Barbara Hauser
January 1998

Barbara Hauser has a Master's Degree in music performance(violin and viola), and has been teaching and performing for many years. She is also a Nationally Certified Massage Therapist and Physical Therapist Assistant.

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As a performing musician, do you consider yourself athletic? Do you care for your body as a major league athelete would; eating well, getting proper rest, receiving massage or other bodywork regularly? Do you strenghten and stretch the muscles that work so hard for you in performance? Many musicians are still afraid of the stigma attached to becoming injured, and are reluctant to use worker's compensation claims or to have any other musician's hear of their plight. Many are still afraid to reach out for help, ignoring and/or denying their pain for years. Some common sites of pain for working musicians are the sholders, elbows and wrists: rotator cuff injuries at the shoulder, tendonitis at the elbow (where the finger muscles cross the joint), thumb and wrist tendonitis, and carpel tunnel injuries. Why not prevent the problems and their attendant pain?

First, consider yourself an athlete. The tendons and muscles we use in performance are put under constant repetitive stress in a high-focus environment. For the orchestral or chamber musician, most performances consist of nearly two hours of continuous playing. These demands are intensified in solo performance. Therefore, the fist thing to consider in helping musicians to cope with this demand is: What kind of aerobic activity do you like and could you do for 30 minutes at least 3 times a week. Many musicians only "lift books"; anything vaguely resembling exercise or "pumping iron" is thought of for the "athletic" types.

In order to motivate yourself to exercise, find something you enjoy. Walking, swimming, racket sports, running, hiking, biking -- all are fine aerobic exercises for the musician. (Be careful with racket sorts and biking if you currently have shoulder, arm or hand problems.) The body will feel better, because it will produce its own natural morphine called endorphins. This is why runner's get addicted to their "highs". Endorphins are complex and consist of three different types. They help to lift the clouds of depression that often form around performing musicians. (Often musicians have dysfunctional family backgrounds, which may be part of the reason they chose to become musicians and also why they have vivid musical imaginations.) Exercising helps to bring the mind and body together; dysfunction is temporarily left behind to create wholeness. Other benefits of exercise include increased blood flow to injured areas, improved sleep and decreased anxiety. Many people express something to the effect of "I feel like a different person after a good workout." This is all due to the movement, the muscle pumping action and the resultant endorphins.

When the aerobic workout is done, the proper heart-rate should be calculated to achieve the endorphine effect; subtract your age from the figure 220 and take 80% of that to get the beats per minute for the target heart-rate part of your aerobic workout. Your calculation will look something like this: 220 - 33 = 187 beats per minute. Now multiply this by 60-70% if you have heart problems, are a smoker or have other major health problems. If you are relatively healthy, multiply by 80%. For our hypothetical person of age 33 above, 80% of 187 is 149.60. Round that off to 150 beats per minute; this person should exercise at this rate to get the greatest benefit from her workout. Taking her pulse to find this rate can be done at the wrist, just below the base of the thumb or at the center of the neck, near the jugular vein. Most people find it easier to calculate this rate by taking the pulse for 15 seconds and then multiplying by 4 to find the rate for a minute. In a thirty minute workout then, the first 5 minutes should be a warm-up at the resting heart rate, the next 20 at or approaching the target heart rate (for the 33 year old, remember that was 150 beats per minute) and the last 5 minutes a cool-down towards the resting heart rate.

The second thing of major importance for musicians is to do some kind of stretching and strengthening routine. Most of us are not aware of how unresilient we become after performing for hours on chairs that are not ergonomically sound for our bodies. Stretching keeps the body limber and warm. Find some form of stretching that suits you and your temperament. Many musicians like to practice yoga, others prefer a combination of stretching and strengthening that something like martial arts or Pilates method, or Gyrotonic Kinetic Activities can provide. (Pilates method and Gyrontonic Kinetic Activities were originally desinged for dancers, and use a machine for a combination of stretching and strengthening.) These disciplines teach us to use and lengthen postural and extremity muscles.

There are many books now on the market for repetitive strain injury prevention; some of these are very good and have excellent illustrations of the exercises. There are also more traditional stretch books, some with special sections for different athletic activities. Stretches should include one for every major muscle group in the body, and especially the rhomboids, upper and middle trapezius, the biceps and triceps and wrist and finger muscles. It is important to remember that the body is a whole; stretching the lower part of the body (the large muscles of the back, legs and buttocks) will increase flexibility in the upper body and vice versa. Stretching should be done during rehearsals and after performances. Stretching before rehearsal or performance is also appropriate, if done very gently and in moderation, as muscles which are warmed up with use stretch more easily.

As for strengthening, most musicians can benefit form martial arts kind of strength and/or low impact weight training. Low weights (not more than 5 pounds, generally) and theratubing or theraband are healthy ways for musicians to keep their trunk and extremity muscles fit and trim for performance. The theraband comes in a variety of weight simulations (by color coding) and can be taken along on runouts and tours. A low impact workout, consisting of biceps curls, triceps push-ups or pull-down, pectoralis flys, some kind of rowing simulation and wrist curls can all be done on the tubing. This kind of work out does not tax the muscles that are so delicate and so prone to injury over the years of performance.

Another very fun way to work out is with the gym balls especially designed by a physical therapist in Switzerland. Stretching and strengthening can be done on the balls. There are some books out about this combination, as well, but as with anything worth doing well, it is always good to have an expert coach to facilitate correct movements and prevent injury. This last thing we want is for the already compromised muscle system of the performing musician to be injured trying to strengthen or stretch!

The third key element for musicians to consider is: How is my posture when I play? Am I comfortable? Does my instrument itself cause problems? Often the answers to these questions are key to playing with ease and agility. There are often minor adjustments that can be made to an instrument (for example, John Lunn has many good ideas to offer flutists in this regard). In addition to the ideas currently offered by some instrument makers, there are some ergonomists and Drs available who specialize in musicians problems arising from improper positioning of bodies and instruments. There are also many clinics specializing in the problems of performers: a recent International Musician's Journal published an ad for such a clinic.

Posture affects muscle tension and arm/shoulder girdle positioning when performing. Good posture also facilitate optimal blood flow and nutrients to the muscles, nerves and tendons of the arms. All of these things are so necessary for high level performance. In regards to postural training, it is worthwhile mentioning several good methods out there for musicians to study. There are Alexander Method, Aston Patterning, Kato Havas Method, Feldenkreis. There is also the study of biofeedback and the general postural work that can be studied within the discipline of physical therapy. Good posture and gait is something that any good physical therapist should be able to teach well. Many musicians do a combination of things to help the postural muscles to relax and algn themselves. There are many forms of masssage that can be combined with postural work to help the musician perform optimally. Chiropractic, osteopathy and acupuncture are often helpful in the case of already existing and chronic musician's problems. They are also wonderful preventatives for musicians. A regular routine of whatever the particular musician finds helpful in prevention is the best antidote to the kinds of physical and mental anguish that repetitive strain injuries can bring.

Another thing that is very important to consider in preventing and treating repetitive strain injury in musicians is the diet. Junk food and overdosing on sugar can cause problems, because they deplete our energy. Sugar can make us feel sluggish and tired. Hardly the state we want to be in when performing. Try to eat a healthy, balanced diet with lots of fresh vegetables and fruits. If you like pineapple, it contains a natural anti-inflammatory (bromelain) for your tendons. Other natural anti-inflammatories include vitamin C (2,000 to 3,000 mg a day), echinacia,calcium, kelp, and vitamins A and E. There are also herbal remedies such as white willow, fresh cramp bark, and prickly ash. There is a whole list of natural anti-inflammatories available in most health food stores and various books on how to eat a healthy diet and get optimum performance from your body. Drink plenty of water. Think of yourself as an athlete in training; it helps to prevent you from giving in to the "junk-food" routine on tours and runouts.

It is important also to think about the emotional problems that can occur if a musician is afflicted with some kind of repetitive strain injury. It is very common amongst repetitive strain injury patients to have (or develop) underlying anger, frustration and heavy depression. Life seems hopeless; we cannot perform, we don't get paid, we don't have our usual and customary place amongst our peers. Life can seem really dark to someone with repetitive strain injury. The most important thing to keep in mind in this precarious state is to try to avoid "going into the black hole" of despair. Despair and depression only bring on more pain. Try to find the routes that you can relate to that will bring you back to health and wholeness. Try to visualize yourself as healthy. One very positive practice is daily visualization; it can be fun and easy. Picture yourself in a desert almost dying of thirst. You can think of nothing but a long cold drink of water. You come across a shelter and someone hands you a lemon. How many of us can imagine this scene without licking our lips or screwing up our faces? Visualization can have just this kind of powerful effect on our bodies. Your positive thoughts will keep you healthier and happier.

Another very helpful way to train your mind and muscles is the study of biofeedback. This system uses a computer to show you how your muscles work as you stand and move. It is an excellent tool for gaining self awareness to modify posture or movement habits. Biofeedback is also used to train hand-warming skills, i.e. to increase blood flow. Nerves and tendons have relatively poor blood supplies and heightened blood flow has been associated with reduction of pain and symptoms in the extremities.

If visualization or biofeedback aren't for you, some kind of relaxation exercise or meditation can provide a quiet time that rests tissues, increases endorphins and facilitates healing. One very simple way to relax is to lie in a comfortable position and breath deeply from the diaphragm. This is a skill often taught in biofeedback sessions and in some forms of massage. Singers and wind and brass players use this technique, as do people who have suffered heart problems. Deep, diaphragmatic breathing can make performing (and driving in bad traffic or dealing with lots of other daily irritants) more relaxing and controlled. This is also a good way to lower blood pressure.

Above all, stay out of the pit of despair; it will facilitate healing. We all want our colleagues around us to be functioning on high mental and physical levels; after all, we are all in this as team players. The better we perform in our spiritual, mental and physical bodies individually and collectively, the sooner we will elevate the spirit of the arts and the world which is so in need of healing in general. Take command of your bodies and minds to prevent repetitive strain injury. Think of yourself as an athlete. Stay healthy!

Printed with the permission of the author

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