It is estimated that 47 percent of adults and 17 percent of high school instrumental musicians experience playing-related musculoskeletal injuries. Despite such prevalence, these injuries often get ignored and may last a number of years.

It is estimated that 47 percent of adults and 17 percent of high school instrumental musicians experience playing-related musculoskeletal injuries. Despite such prevalence, these injuries often get ignored and may last a number of years.


Many common playing-related musculoskeletal injuries are due to overuse. These conditions often lead to neck, back, arm and face pain. Contributing factors include repetition of movement, hours of practice and awkward postures while playing.


A key component of injury prevention is the manner in which the musician interacts with the instrument. The musician's size in relationship to the instrument is very important. Instruments should be fitted to the user for the best ergonomic advantage. A properly fitted instrument will lead to better posture while playing.


A "neutral" or well-aligned posture requires sufficient strength and flexibility. For example, if an instrument - such as a saxophone - is too large, the musician may hold his or her head and shoulders in a forward position. This will lead to muscle tightness in the front of the neck and shoulders and muscle weakness in the upper back. This muscle imbalance could lead to shoulder tendonitis or neck pain.


In addition, physical conditioning is not stressed in most music programs at schools or conservatories, yet music students spend more hours practicing their instrument than an athlete practices their sport. Physical conditioning is important for cardiovascular health, strength, flexibility and posture.


Another important component of injury prevention is the playing environment. Music students who practice greater then 20 hours per week have been found to have more playing-related injuries. A sharp increase in practice time is also associated with higher prevalence of injuries. A break of 10 to 15 minutes should follow a 30- to 60-minute practice session and a gradual increase in playing time is recommended.


Additionally, lifting heavy equipment and cases, especially if using poor lifting mechanics, can contribute to overuse injuries. Consider using a soft instrument case and transporting equipment on wheels rather than carrying it long distances. Proper body mechanics for lifting includes keeping the back in a neutral position and bending at the hips and knees rather then rounding the back.


Proper seating and lighting can also impact injury prevention. Correct seat height, depth, padding and degree of back support will encourage a "neutral" postural alignment. Music stands should have correct lighting to reduce glare and correct height (a viewing angle of 20 to 30 degrees below the eyes is best) to prevent awkward neck positions.


"Neutral" posture is the goal! While playing, posture and alignment can be videotaped or viewed in a mirror. Look for the head to be facing forward when possible. Feet should be flat on the floor. The back should not be rounded or slouched. Use a lumbar support when playing in a sitting position. Visualize that you are being pulled up from the top of your head by a string and then gently pull your shoulder blades back, down and together. Combining proper equipment, postural awareness, proper flexibility, strength and conditioning can be an effective way to prevent overuse injuries.


If you already suffer from an overuse injury, early identification and treatment of the problem are critical. Some musicians will minimize a problem in order to continue to play. This only leads to further problems and may prolong recovery, leading to lost playing time. Avoid playing in pain. When returning to play, start with short sessions and gradually increase playing time. Injuries can take up to six weeks to heal.


If symptoms are severe or do not resolve with rest, seek medical care. There are physicians who specialize in playing-related musculoskeletal disorder.


Taking care of a body that produces music is the greatest gift musicians can give themselves and others.


Beth Grill is a senior physical therapist at Massachusetts' Spaulding Framingham Outpatient Center with over 20 years of experience. She has a special interest in treating individuals with vestibular, neurological and musculoskeletal disorders.