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 a playing-related injury at some point in their lives. When I’ve written and talked about my past injury, other pianists have come out of the woodwork asking for advice on how to deal with their own.
My problems began about 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 sensations, weakness, and areas of numbness in both arms.
I had taken a piano pedagogy class where they talked about repetitive strain injuries, but I wasn’t paying close attention because I assumed it was never going to happen to me. When I realized I had a problem, I didn’t know what to do other than panic.
When a musician gets injured, it presents an existential threat. Your whole life plan comes into question because it all 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 often talk openly about it. As a result, those suffering from injuries don’t know how many of their peers are in the same boat and they feel more isolated than they actually are.
On top of all that stress it’s hard to figure out what to do. Outside the music world, a standard medical approach to a repetitive strain injury is to rest for a while, seek treatment to aid in the recovery (physiotherapy, massage, etc.), then do less of the activity that caused the injury. For a musician this is not much of a solution.
In order to truly recover, the post-injury conditions must be somehow 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 an injured musician.
Play the long game
By the time injury symptoms show up, there is probably already a long backstory. An imbalance of some kind has likely been 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 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 in the long run.
Fix your technique
First, a bit of perspective. Playing the piano, violin, or most any other 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 and precise movements for long hours in a relatively fixed position. It’s not surprising 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 healthy piano technique.
A lot of musicians play with far 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. If they did you would probably collapse on the floor.
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 of the way there. It will certainly help, but the best possible teacher for this is a specialist on your instrument who addresses the participation of the entire body. Most high level teacher-performers can offer good guidance.
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.
When I was injured, I was fortunate enough to get into the studio of Marc Durand, who is probably one of the best teachers on earth for injury-proof piano technique. After just a short while studying with him, complemented by my Alexander training, I got to the point where practicing made my arms feel better instead of worse. That’s what you want to aim for.
(Durand has since retired from teaching, but if you’re a pianist looking for guidance, drop by and see me at my studio in Montreal.)
If possible, it’s 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 hinder your capacity 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 helpful and others are not, so it’s important to do your 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. Massage therapy, osteopathy and NSA chiropractic are three options I have tried and liked.
Musicians can often find understanding clinicians in the world of sports medicine. People in that field are used to dealing with 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 tests. There was no overarching diagnosis or medical condition with a fancy name, but that didn’t seem to matter much. He had plenty to say about the strategies needed to recover.
Act like an athlete
Dr. Chong told me to start acting like an athlete, which meant eating well and exercising in ways that integrate the whole body. He recommended the book Core Performance by Mark Verstegen, which borrows from both Pilates and Yoga (two other good options) and also includes some traditional strength training with emphasis on proper body alignment and the participation of core muscles.
I started doing some of the easier movements and felt better immediately. My all time favourite stretch – the one I feel best mitigates the effects of a forward-focused playing posture – is the scorpion.
It’s important to remember, as any Alexander or Feldenkreis 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 slow, and listen to your body if something feels wrong.
Dr. Chong also stressed the importance of an athletic mindset and asked me a bunch of questions about my past and present life circumstances. This confirmed what I already felt to be true – that the creation of my injury involved much 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 (or at least the first two if you’re an atheist). This is not easily accomplished in the modern world but it’s the only way to maintain true health over the long term.
Early on in my journey I started seeing a chiropractor in St. John’s with a very holistic philosophy. Her treatments were subtle and she barely touched my arms, but I felt some real improvement afterward 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 my clients about this, and I can tell you it’s not weird.”
Who knew? Apparently there are lots of people who 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.
Over the course of one long session with this therapist, I found out how I felt. Without getting into too much detail, my adolescence and early twenties were more traumatic than I had previously allowed myself to acknowledge. Along the way I had 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, read the book When the Body Says No by Dr. Gabor Maté. He goes deep into the chemistry of how repressed emotions become physical illness.
The sense of relief I felt in reconnecting to my emotional self is hard to describe. It felt so important that it didn’t matter whether I ever played the piano again. The way forward from there was not easy or convenient, as it included ending a relationship and moving to a new city, but I knew it was right.
Once I had untangled the web of unsustainable patterns I was stuck in, things gradually improved. Within a year of starting school in Toronto, I went from injured and unable to practice without pain to playing big recitals and feeling good on stage for the first time in years.
Because I ultimately recovered, I can say now that getting injured was one of the best things that ever happened to me. Of course I know it’s not guaranteed to end that way, and my heart goes out to any musician currently struggling.
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.