Playing-related injuries are rampant in the classical music world. If you’re a performer and have never dealt with one, you’re an exception to the rule. Surveys of classical musicians typically come back with numbers like 50-80% having dealt with playing-related pain or injuries. When I’ve written and talked about my injury experience, other pianists have come out of the woodwork asking for advice on how to deal with their own.

My problems began midway through my undergraduate degree when I started feeling pain in my right forearm. Not long afterward similar pain showed up in the left, then tingling, weakness, and areas of numbness in both arms.

When a musician gets injured, it presents an existential threat. Your whole life plan comes into question because everything depends on being able to play your instrument really, really well. As if that wasn’t hard enough when your body was fully cooperating…

The stress of an injury is compounded by the pressure of maintaining a professional reputation. As a performer, you try to project an image of someone who dependably gives stellar performances – that’s how you get booked to play. Being injured makes you look less dependable, so musicians don’t usually talk openly about it. As a result, those suffering from injuries don’t know how many others are in the same boat and they feel more isolated than they actually are.

On top of all the stress, it’s hard to figure out what to do. The standard medical approach to a repetitive strain injury is to take some pills, rest for a while, seek physical treatment like massage or physiotherapy, then do less of the activity that caused the injury. For musicians, this is not much of a solution.

In order to truly recover, the post-injury conditions must be different from the conditions that led to the injury. You have to figure out what needs to change and change it. For me, that process became a deep examination of many aspects of my life, and it took a while to find the right path. Looking back, here are the best pieces of advice I have to offer.

Play the long game

By the time injury symptoms show up, there has probably been an imbalance of some kind present over a period of months, years, or even decades. The body keeps it together for as long as possible despite the unfavourable conditions, but when it can no longer handle those conditions it breaks down and demands your attention.

If the development of an injury is gradual, the recovery will likely be the same. This is not convenient when there are performances coming up, but you may have to take a hit in the short term and be patient. Frame the injury as a challenge and an opportunity to learn, which will make you a better musician and a healthier person in the long run.

Fix your technique

First a bit of perspective. Playing the piano, violin, or most any classical instrument, is not a particularly natural thing to do with a human body. We are designed to walk, run, jump, climb, build things with our hands and dance around the fire, not to repeat incredibly complex movements for long hours in a relatively fixed position. It’s not surprising that our bodies have trouble dealing with this kind of treatment. 

That said, we are amazingly adaptable creatures and many people have figured out how to play virtuosic music in ways that respect human anatomy. Playing can become not only healthy but an artful display of physicality that heightens the musical expression and feels euphoric for the person playing. 

A common recommendation when an injury happens is to pursue a system of whole body movement re-education such as Alexander Technique, the Feldenkreis method or Body Mapping. In each system, a certified teacher leads you through physical practices aimed at achieving a fuller awareness of body alignment and movement patterns, and thus a healthier way of moving applicable to all activities. I took Alexander lessons for several months and it was a great start down the path toward healthier piano technique.

A lot of musicians play with more muscle tension than necessary, and letting go of the extra tension is crucial. It may sound like a simple enough problem to solve – just relax the tight muscles, right? Unfortunately not. Muscles tighten up to compensate for imbalance and misalignment in the skeletal structure, so they can’t let go until those issues are corrected.

The best way to achieve optimal muscle tension is not to focus on muscle tension, it’s to think about your bones. You have to align your bony structure (an Alexandrian term) so it supports you properly in whatever you’re doing, and the tight muscles will let go when they can.

If the goal is to play insanely difficult music with efficient technique, a general movement practice may not get you all the way there. It will certainly help, but the best possible teacher for this is a specialist on your instrument who addresses the alignment and participation of the entire body.

I work with pianists online in 1-on-1 lessons. For more information about my teaching, click here.

If you can’t work with a teacher, performance videos on Youtube can be a good resource. Watch for players who appear to be using their bodies well and imitate them. You develop a keen sense of this after studying Alexander or Feldenkreis for a while.

After a short while studying with the right piano teacher, I got to the point where practicing made my arms feel better instead of worse. That’s what you want to aim for.

If possible it is best to temporarily abandon most or all of your pre-injury repertoire while reforming your technique. Any music you’ve been playing for a while will have physical habits built into it that will impede your ability to change.

Assemble your pit crew

There are all kinds of well-intentioned medical professionals out there who will try to help an injured musician. Some are effective and others are not, so it’s important to research and find the right people.

Some form of hands-on body work will definitely aid in the recovery, and is a good idea anyway for ongoing maintenance anyway. Massage therapy, osteopathy and NSA chiropractic are three options I have tried and found helpful.

Musicians can often find understanding clinicians in the world of sports medicine. Workers in that field are used to patients who place extraordinary demands on their bodies and have no intention of stopping. Better yet, there are a few clinics out there dedicated to treating performing artists and musicians, like the Al & Malka Green Artists’ Health Centre and the Musicians’ Clinics of Canada, both in the Toronto area. 

I was referred to Dr. John Chong at the MCC, who happens to be a pianist in addition to a specialist in treating musicians’ injuries. He did some tests including one where I played the Steinway piano in his Hamilton office with a bunch of sensors taped to my back, shoulders and arms. He told me my shoulders were tight when I played (no surprise there) and I had low strength in some of the other muscle tests. There was no overarching diagnosis with a fancy name, but that didn’t seem to matter much. He had plenty to say about the strategies needed to recover.

Treat yourself like an athlete

Dr. Chong told me to start acting like an athlete, which meant eating well, exercising my whole body and fostering a positive, energetic mindset. He recommended the book Core Performance, which borrows from Pilates and Yoga (two other good options) in addition to traditional strength training. I started doing some of the easier movements and felt better immediately.

My all time favourite stretch to counter the effects of a forward-focused playing posture is the scorpion.

It’s important to remember, as any Alexander teacher will tell you, that even the best exercise done incorrectly has the potential to hurt you. You absolutely must learn the proper form, start slowly, and listen to your body if something feels wrong.

Dr. Chong also asked some questions about my past and present personal life, which confirmed what I already felt to be true – the road to injury had involved more than just piano playing.

Address your stress 

To be a healthy musician over a long career of practicing and performing, you have to be a healthy person in body, mind and spirit. This is not easily done in the modern world but it’s the only way to maintain true health over the long term.

Early in my journey I started seeing a chiropractor with an unusually broad, holistic approach. Her treatments were subtle and she barely touched my arms, but I felt some real improvement so I kept going. 

During one of our sessions I mentioned that I thought emotional stress was contributing to my problem. She asked what I was feeling…

I paused for a second and answered, “I don’t know. It’s weird.”

She replied, “I talk to a lot of clients about this and I can tell you it’s not weird.”

Who knew? Apparently lots of people don’t know how they feel. She suggested I see another therapist at her clinic to explore it further. It sounded weird and scary to my 22-year-old self, but I did it anyway.

The therapist helped me uncover how I felt, and it turned out my adolescence and early twenties had been more traumatic than I had previously acknowledged. Along the way I dissociated from my feelings and escaped into music where things were going OK and I knew how to handle myself.

Playing music is a way of acting out emotion but not of processing or clearing it, so the trouble was always there beneath the surface. When you dissociate from feelings they don’t just go away. They stay in your body and manifest in indirect ways, sometimes as physical symptoms. If you’re not convinced of that, check out the book When the Body Says No by Gabor Maté. He goes deep into the chemistry of how repressed emotions lead to illness and disease.

I felt a powerful sense of relief in reconnecting to my emotional self. The way forward from there was not easy or convenient, but I could feel in my body that it was right.

Because I ultimately recovered, I can say that getting injured was one of the best things that ever happened to me. Of course I know it’s not guaranteed to turn out that way – it depends on many factors, some of which may be beyond our control – but it is possible.

Given the resilience and healing capacity of the human organism, I believe that for most injured musicians there is a way through it and out the other side, and on the other side they will be stronger, wiser, healthier and more musical.

I work with pianists online in 1-on-1 lessons. For more information about my teaching, click here.