Musculoskeletal Injury Prevention and Mitigation

by Todd Goranson

In addition to addressing performance anxiety and emotional wellness (see prior two issues of Horn and More), musicians should strive to be proactive in maintaining their physical health. As “artist-athletes,” musicians must be able to perform the athletic elements needed for tone production, articulation, technique, and listening if they intend to present art for their audiences.

The horn player is exposed to a variety of performance injury risks, including several musculoskeletal issues. Additionally, the repetitive physical demands on the performer can make it easy to dismiss a problem until it finally disrupts the ability to perform. Recent studies have shown the lifetime incidence rate for performance-related injury to be anywhere from 46-90%.^[1]

Performing musicians should benefit from being as “body-aware” as professional dancers. The adage to “play through the pain” when we experience discomfort must be replaced with an acknowledgement that any pain sensation is the body demanding attention. Is the lumbar region of your back sore from “twisting” during a long practice session? Do your lips or teeth experience sensitivity from mouthpiece pressure? Do your joints become sore, or do you experience a change in sensation in your fingers? These are all potential indications of strain or injury and require immediate attention; ignoring something as simple as “embouchure burn” or cramping can develop into an injury. Perhaps the most important step we can take to prevent or mitigate musculoskeletal injury is to notice and then stop and assess possible causes of the discomfort or change in sensation. It is also critically important for educators to remind students that they must rest, even if briefly, if they experience embouchure or joint pain. I remind each of my students that it is their responsibility to talk with me if they experience any pain from playing. Repetitive use injuries, such as carpal tunnel syndrome and tendonitis, often result from ignoring discomfort until it progresses into a debilitating issue.

Proper body alignment (including that of our head, neck, shoulders, back and hips, wrists, hands, and fingers) when sitting or standing with our instrument is a primary goal, and efficiency is our friend in this matter. Ease of movement, as well as maintaining straight lines or gentle curves in hands and joints when holding and playing is paramount. Sit in a tall, athletic position (i.e. feet bearing the weight of the legs on the floor, distributing the weight of hips and upper body across the surface of the chair, head floating above the shoulders, shoulders above the hips, etc.). The asymmetrical nature of horn playing makes it easy to misalign the spine or put excessive pressure on the hips, lower back, and parts of the left hand. Some horns include an adjustable flipper and pinky hook for the left hand, while most others can be adjusted by a trustworthy repair technician. This is an inexpensive investment in your long-term health and comfort and should be a topic of discussion with your horn students, as well. Consulting an Alexander Technique instructor (and bringing your horn to a session) is a great starting point for optimizing posture and carriage. Pain or damage from excessive mouthpiece pressure as well as repetitive use injuries to the hands/wrists are common risks for the horn player. Body awareness and regular intervals of rest in our practice routine are invaluable tools for addressing these issues. Do not dismiss pain as “growing pains” from increased practice, advancing age, or a badge of honor for hard work.

The benefits of implementing a daily routine that includes warming up and stretching the upper body and extremities are well-documented.^[2] Several of the stretches that I employ in my own routine are demonstrated in YouTube videos that are linked in my endnotes for this article.^{[3] [4] [5]} (Disclaimer: always consult with your primary care provider before starting a new exercise or stretching regimen, and never continue a stretch if it results in pain or loss of sensation.) Warming up cold muscles and joints and resting tired ones should be considered “best practices” in our field. If we expand our awareness during practice and performance time to notice tension in our back, neck, shoulders, or hips, we can often easily address the issue with basic stretches or with rest.

There are many well-written online resources available for horn players (and musicians, in general) addressing common musculoskeletal issues and to how address them. These are certainly worth exploring. I also recommend having regular discussions with your primary care health provider about concerns you may have about changes in your health. Many of you may have musician/sports medicine specialists in your area, and your physician should be able to provide a referral to these or other physical/occupational therapists if a visit is advised.

Other keys to injury prevention and mitigation include proper nutrition, adequate sleep and rest, and regular exercise that enhances both strength and flexibility. Giving our bodies the attention, rest, fuel, and care they need will increase the likelihood that we can meet the physical demands of our craft without injury or, if necessary, recover from injury with greater success.

Todd Goranson, DMA, BSN, RN
Professor of Saxophone & Bassoon
Messiah University