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December 2009

Injury Susceptibility in Musicians

by Janet Horvath, Cellist and Author of Playing (less) Hurt

I was born into a musical family, my father is a cellist. At the time of his retirement he had performed with the Toronto Symphony for 38 years. My mother enjoyed a successful dual career as singer and piano teacher. For all my early years, music permeated our home, and there was absolutely no question that I would become a musician. My lessons began at the age of nine, and by the age of 22 I was accepted by the great cellist and pedagogue Janos Starker at Indiana University.

I embraced the prevailing mentality, borrowed from the aerobics boom, that physical discomfort was an outcome of time well spent: "No pain, no gain." So, practicing up to 4 hours per day, I played with a sore arm with the rationalization that I could play through the pain and that the discomfort would just miraculously go away as I got into better shape as a cellist. But the pain didn't go away. It got worse. I developed a major case of what we now call overuse, or repetitive strain injury (RSI). I stopped practicing altogether and saw many doctors, most of whom told me it was all in my head. For several months I didn't play at all, then gradually I relearned how to play without tension.

Since those student years, I have encountered countless musicians in various stages of denial or shame concerning their very real pain. Admitting to a problem ultimately means reckoning with it, making changes to playing technique or habits and oftentimes taking a hiatus from playing altogether.

Due to overwhelming interest in the subject I approached the University of Minnesota in 1984. They agreed to sponsor a national conference called "Playing Hurt™ ", which took place in 1987. Twenty three states were represented by the several hundred attendees. Doctors addressed musicians, pedagogues addressed doctors, and musicians shared their stories with musicians. It was cathartic, and a huge relief for everyone to finally talk about this to a receptive audience and to explore solutions. The field of performing arts medicine was given a shot in the arm.

Today performing arts medicine is an established medical field. Clinics have sprung up all over the country. More and more music schools have advocated for injury prevention programs and there is an awareness in the orchestral world as never before. In the book Playing (less) Hurt, we delve closely into the hows and whys of injury. Remember that this is a new and growing area of understanding and healing. The lessons we are learning are only as good as the teacher and advocate that you become for yourself and for others.

Listed below is an Injury Susceptibility Quiz. If your answer to many of the questions is yes, you may be putting yourself at risk for an injury. Overuse injuries can creep up on you.

Injury Susceptibility Quiz:
  • Does your teacher have an intense teaching style?
  • Is your playing style intense, emotional, macho?
  • Is your position awkward or uncomfortable?
  • Do you have a predilection for difficult, pyrotechnical, challenging, loud repertoire?
  • Do you love to slam your bow or slap your fingers into the strings?
  • Do you practice mostly at the forte dynamic range?
  • Do you squeeze your instrument while holding it?
  • Do you jam the keys down, even when playing softly?
  • Do you lose track of time when practicing?
  • Do you have difficulty saying "no"?
  • Do you clench your jaw or grit your teeth?
  • Do you schedule back-to-back rehearsals, gigs and performances?
  • Do you play in spite of fatigue and pain?
  • Do you fling your fingers off strings or keys?
  • Do you grip your bow tightly or grab your fingerboard or squeeze it?
  • Do you play without warming up?
  • Do you play with a heavy bow, keep your strings high or use a worn-out, ill-fitting chin rest?
  • Do you stretch to reach notes or keys?
  • Do you hold fingers uplifted and/or curled?
  • Do you hold stretches, double stops or chords down?
  • Do you snap your elbow when changing from downbow to upbow?
  • Are you a tense, stressed person?
  • Are you depressed?
  • Do you sleep poorly?
  • Are you physically inactive?
  • Are you overweight?
  • Do you consume more than two cups of caffeinated beverages a day?
  • Do you take drugs or drink more than a moderate amount of alcohol?
A playing diary can be a helpful tool. Immediately after practice sessions, rehearsals and performances, note in your diary (or date book) whether you warmed up before playing and whether, after playing, anything aches, tingles or feels stiff. Note also whether any passages were more difficult than usual.

Keep notes for at least a couple of weeks and watch for any patterns that might emerge. Unless we keep notes, it's easy to lose track of when something started hurting or what music we were playing that seemed to trigger our problem.

Remember that not all pain means injury. Prolonged, persisting or chronic pain means something is wrong.

Janet Horvath, author of Playing (less) Hurt, has been the associate principal cello of the Minnesota Orchestra for more than two decades. She is a soloist, chamber musician, writer and award winning advocate for injury prevention. In 1992 Ms. Horvath received the American String Teachers Association Service Award in recognition of her outstanding efforts on behalf of musicians' health. The 2009 edition of Playing (less) Hurt was awarded the gold medal from the Independent Publishers Book Awards. Learn more at