The Musician and Their Instrument

Julie Teal, OTR CHT

My family is filled with musicians including pianists, violinists, and a cellist. Musical talent didn’t come my way, however, but a real interest developed as I watched how musicians use their hands to perform complex motions and maneuvers. I found myself fascinated with the injured musician and began developing observational skills, similar to the skills we use to observe a worker or an athlete. Many of us at HTS have developed this interest either through their own musical instrument studies or for the love of music and find great pleasure in assisting musicians as they return to their instrument.

Fig 1: Middle finger in hyperextension, Ring finger with Silver Ring splint in slight flexion

Musicians are athletes. They have the same motivation as an athlete – to strive for excellence in their craft and a desire to return to play as quickly as possible after an injury. We find them to be compliant in performing their exercise program due to this motivation. Musicians are different from an athlete, however, in that focus on fine movement leaves many deconditioned and often fearful about their injury. Performers who experience injuries, related to their instrument, present many challenges, but you can’t match the enthusiasm when they are able to return to their instrument.

Thirty percent of musicians develop overuse syndromes of the upper limbs. In a 2009 study, published in Medical Problems of Performing Athletes, Dr. Brandfonbrener discovered that 79% of freshman music students had already experienced performance related injuries (1). Overuse is the most common injury we see with musicians at HTS. Treatment consists of using typical therapy modalities to decrease pain and symptoms which may include splinting for rest, development of an exercise program for muscle balance and strength, and assistance in developing a reasonable practicing routine. In addition to these traditional types of treatment, it is also essential that we spend time observing the musician playing their instrument to assist in identifying why the injury has occurred. At times, simple postural or positioning corrections can alleviate symptoms. Since we are not the expert with each and every instrument, we find it helpful to meet with the teacher and the student to utilize the teachers’ expertise to best understand optimum shoulder, elbow, wrist, and hand posture for that particular instrument. Often the musician is doing everything correctly, but simply over-using due to an upcoming performance.

Fig 2: Silver Ring Splint Allows Full Flexion

In addition to overuse, we have seen young violinists and cellists who have hyper mobile finger and thumb joints. As they apply pressure on the strings or bow, their joints hyperextend (Fig 1) which causes discomfort, decreased coordination and speed, and difficulty moving out of the hyperextended position. One example is an 11 year old violinist who has hyper mobile PIP joints (the middle joint of the finger), creating a swan neck posture (the PIP joints hyperextend), making it difficult to hold the correct position on the strings. By applying a splint that blocked PIP hyperextension, and holds her PIP’s in slight flexion (bent), she was able to play without fear of the joints catching in a swan neck posture. The splints keep the joints out of a poor position, and also put the joints at their strongest position of function. (Fig 2,3)

Osteoarthritis presents another challenge to mature musicians. We have been able to extend the playing life and pleasure of musicians through education and adaptation, soft taping and/or splinting to relieve stress on painful joints. In addition, by adapting other stressful activities, such as gardening, joints can be saved for playing.

Fig 3

Fig 3: Violinist with Silver Ring splints

Musicians have particular demands when recovering from unrelated injures, such as fractures. Our experience will support you to regain the motion and strength needed to return to your musical activity.

No matter the age of a musician, if you are beginning to experience discomfort from playing music, therapy may be useful in analyzing the problem to determine the cause. By doing this early on, it will allow the musician to have a long and pain free musical career.

(1) Brandfonbrener AG. History of Playing-related Pain in 330 University Freshman Music Students. Medical Problems of Performing Artists. 2009; 24:30-36.