This article was published in the February 2018 issue of the Southeast Michigan Flute Association Newsletter.
A 2009 study conducted by Brownwen Ackermann, Dianna Kenny and James Fortune concludes that 95% of highly skilled flute students suffered performance-related musculoskeletal disorders, and that 63% of these conditions were chronic and have been present for over 3 months. If you are a part of the majority and experience musculoskeletal pain while you are practicing or performing, your conditions should no longer be ignored. You may have heard phrases like "no pain, no gain", or "play through the pain", but this "no rest for the wicked" mentality can be detrimental to your career over time. I am currently studying performance-based pain in collegiate music students on a research grant through Bowling Green State University, and I have recently issued an electronic survey to all music majors in the College of Musical Arts at BGSU regarding the pain they experience while playing their instruments. The results of my study have proven that 84% of participants are experiencing performance-based pain, and that the majority of students cope with this pain by decreasing practicing, taking time off or changing their technique, but typically do not seek out professional treatment options and are unaware of methods to treat their injuries.
I have suffered from multiple bouts of tendonitis both in my forearms and my shoulders since I was sixteen years old. I have seen many medical doctors regarding my pain, receiving different answers and diagnoses from each one. I am one of the students who is experiencing moderate to severe pain, and do not know how to receive proper treatment for the pain I am experiencing during my playing. I had planned to continue to ignore this pain and to "play through it" until I received a pretty major wake-up call. I could either continue to play through my pain and worsen it to the point where I am jeopardizing my entire career in music performance, or I could start seeking out professional help in an attempt to prevent my injuries from worsening and save my career. My injuries were the forces that initially prompted me to pursue research in performance-based injury in collegiate music students, and through my research I have realized that I am not alone. I realize that it is unrealistic for most student and professional musicians to take time off to properly treat the pain they are experiencing while playing, so I have compiled a short list of various inexpensive actions you can take to relieve pain and improve your overall musculoskeletal health:
1) Take Breaks!
While this piece of information seems obvious, one can never be reminded enough that taking practice breaks is an absolute necessity in preventing and treating musculoskeletal injuries. If you frequently experience pain during your practice sessions, set a timer for the next one and stop it the first second you begin to feel a noticeable amount of pain. This is now your minimum amount of practice time you are allowed before you must take a break. The first time you do this, you may need to stop your timer at 5 minutes. This may be a blessing in disguise! Studies show that the attention span of an average person lasts about seven minutes, and these five-to-seven minutes of extremely focused practicing on a single orchestral excerpt (or passage in your Mozart Concerto) can sometimes be more beneficial than a half hour spent playing the same phrase over and over again. While you are taking your break, hang your arms down by your sides for at least 60 seconds. According to Janet Horvath's book titled Playing Less Hurt, dangling your arms at your sides for just one minute can help restore up to 80% of the fatigued muscles and can also help to relieve a significant amount of pain. Once you're feeling relaxed and rejuvenated again after your break, continue your next segment of practicing until you begin to feel pain again, rinse and repeat. These may be very short increments of time at first, so it is very helpful to create a list of things you would like to accomplish during your practice session to keep you on track.
2) Make Self-Care a Priority!
Elevated levels of stress can both contribute to and worsen performance-based pain. The study I have conducted has proven that a majority of students experience a significant increase of pain the week leading up to a major performance, competition or audition. With a proper preparation strategy, you should actually be playing slightly less the week before a major performance (see Sharon Sparrow's "Week One" chapter from her book titled Six Weeks to Finals!). Trust your preparation process and give yourself permission to take one hour out of each day to relax. With busy class and rehearsal schedules this can sometimes be difficult, but it is very important in maintaining your mental and physical health. This hour can be broken up throughout your daily schedule as well. Turning on a 3-minute meditation tape before you begin practicing (see the free app Headspace), doing a 30-minute yoga tape (see the Fightmaster Yoga channel on Youtube), taking a 30-minute hot bath and watching the next episode of your current Netflix binge in the evening can all constitute examples of making an effort to be more relaxed on a daily basis. We can also reduce our elevated heart rates during times of stress by simply just taking a few moments to take a few deep and centering breaths between tasks, or even sitting down to enjoy our meals. Make a to-do list for yourself, write down each task as it comes to you so that you do not forget, and give yourself permission to take a few moments of relaxation for yourself each day.
3) Stock Up on Tools!
I understand that it is financially unrealistic for most students to schedule regular professional massage appointments and physical therapy appointments to treat injuries, so I have compiled a list of many inexpensive "tools" that you can purchase to have on hand at home to help reduce and relieve pain. All of these items can be purchased at your local drug store or department store:
1) Electric Heating Pad: $18.99, Target
2) Body Back Buddy Trigger Point Therapy Self Massage Tool: $29.95, Walmart
3) Salonpas Pain Relieving Patch: $9.99, Target
4) Village Naturals Therapy Foaming Bath Oil Aches and Pains Relief: $4.97, Walmart
5) Foam Roller for Physical Therapy & Massage: $12.95, Walmart
If I am experiencing a significant amount of pain and still have a few rehearsals scheduled for the day, I like to put heat patches on the affected areas to help alleviate and prevent further injuries. In the mornings when I wake up and in the evenings before I go to bed, I use the back massager buddy to loosen up excess tension in my shoulders and upper back, and I sometimes put the foam roller in between my shoulders vertically or horizontally between my neck and shoulders and lie flat on the ground. The electric heating pad can come in handy to prop against your upper or lower back while you are doing homework, reading or resting for a short period of time, and the bath oil can provide aromatherapy for a relaxing evening indoors. Please be careful in using any massage tool, and be wary that any shooting or sharp pain you feel means that you must stop right away.
4) See A Doctor!
If your pain is consistent every time you play and is worsening, it is very important to seek professional medical assistance. Examples of moderate to severe warning signs of musculoskeletal injuries in musicians include pain that persists after you stop playing your instrument, tingling or burning sensations, and loss of grip or pain while gripping an object. If you have experienced any of these, you should contact a doctor to receive a proper diagnosis. Common injuries like tendonitis are treatable, but it is important to be aware of them in their early stages. More severe injuries such as carpal tunnel are also treatable, but can require different medical attention. It is also wise ask your doctor to run a blood test for any gluten or dairy allergies/intolerances if possible. According to the book Performance Without Pain by Kathryne Pirtle, dietary restrictions can be a huge contributor to musculoskeletal injuries and can often go overlooked by musculoskeletal and orthopedic doctors. It is best to explore these possibilities as well in case your personalized injury can be mostly cured by a shift in your diet.
5) Stay Active!
According to my physical therapist, Dr. Erik DeMeulemeester, "musicians should treat themselves as athletes and condition themselves as such". We often forget that our profession is physical, and that holding up our flutes to play for multiple hours each day requires us to exercise regularly so that we can maintain strength in our posture. Exercising regularly will not only help to prevent injuries (as long as you are always maintaining proper form), but it will also help to build endurance in your breath support so that you can flawlessly make the last breath in your Mendelssohn Scherzo excerpt. For flutists dealing with and treating injuries, using elliptical machines at your local gym, walking or cycling for cardio is slightly easier on your muscles than running. Building core and leg strength by doing sit-ups, leg lifts, squats and planking is crucial in injury prevention and treatment, because maintaining a strong stance from the ground up while you are playing will help reduce tension in your neck, foreams, shoulders and upper back. A good way to give your body a friendly reminder to build support from the ground is to practice some long tones or scales while doing a wall-sit to engage your core and quads. While it is often unrealistic to begin a rigorous exercise regimen in your daily life, aiming to hit the gym or do a yoga tape just 3-4 times a week for a half hour minimum can already make a huge difference. However, if you begin feeling shooting or tingling pain at ANY point during your exercise, stop immediately.
It is so important to remember to take care of your body, and this can become difficult in times of stress. There are many habits you can change in your daily lifestyle that will render positive effects in reducing pain while you perform, and many of these all come down to being more mindful of your actions. Be mindful not to grip the steering wheel while you drive or your toothbrush while you are brushing your teeth. If you are in pain, take a break if possible and do not try and play through. Try to leave with an ample amount of travel time to each event you are attending so that you are not rushing, and take time to deeply breathe a few times each day. When you are feeling stressed or anxious, your breath can be the most stabilizing force available. Be sure to take proper care of your body so that you are able to lead a health and prosperous career in music performance.
By: Francesca Leo