Rethinking Pain: What If Your Technique is the Culprit?

(Originally published September 15, 2020)

On a sweltering summer day in 2015, I sat in a masterclass at ARIA International Music Academy and listened incredulously to Bayla Keyes, Professor of Violin at Boston University,  tell a room full of violinists that we should be able to play eight hours a day. Not only that, but we should physically feel better by the end of the day than when we started! How could this be possible when upwards of 88% of violinists report incurring an overuse injury at some point during their career?¹

As a violinist who has struggled with musculoskeletal issues for the past decade, I felt skepticism. During my undergraduate degree, I’d seen an extensor tendinitis diagnosis develop into thoracic outlet syndrome and undiagnosed nerve pain for three years. I was fortunate to work with supportive violin teachers who taught me how to practice efficiently and physical therapists, naturopaths, and bodyworkers who treated my symptoms. However, the effects of bodywork and therapy were temporary. I would return to my practice room and manage the pain and tension creeping back in long enough to put in an hour or two’s worth of work, if I were lucky. Performances were even worse because it always felt like I was in a race against the clock to make it through a piece before my arms became too fatigued to maintain my technique. 

To me, playing the violin had become synonymous with tightness and pain. 

But I believe now that Bayla Keyes was onto something. She explained that if we use our muscles, joints, bones, and ligaments as they are designed to work ideally, our movements will be effortless and allow us to play for hours on end without tension. Many musicians view soreness, fatigue, and pain as occupational hazards from long days of rehearsals or practice sessions. They regularly stretch, get massages, and use the occasional pain-killer or muscle salve to counteract the expected symptoms. However, this preventative and rehabilitative care only goes so far when the root of the problem lies in the violinist’s misuse of their body while playing. Eric Franklin, internationally-known dance instructor and movement educator, explains that when you move with excess tension or misalignment, your brain integrates those negative qualities into its neural representation of the movement. Practicing it over and over cements the compromised movement pattern in the brain and body.² Franklin cautions that it is difficult to notice bad alignment or inefficient movement patterns if they become habitual, which often leads to overuse injuries.³ Correspondingly, I found that my chronic fatigue and pain while playing persisted until I began to prioritize eliminating tension in my violin technique, address issues of alignment, and incorporate anatomically correct and efficient movements learned in Pilates, Gyrotonic Method, and Franklin Method classes. 

Faulty technique and bad posture are two of the top five risk factors identified by violinists suffering from performance-related musculoskeletal injuries (PRMI) and performing arts medicine professionals (additional high-risk factors include long hours of practice, sudden increases in playing time, and insufficient rest breaks).⁴ Indiana University professor Dr. Brenda Brenner states that “understanding how to build string technique correctly from the beginning through advanced levels, establishing mastery at each stage so that the students can effectively execute the technical issues as well as perform musically and contribute creatively to the process are integral to fine string teaching.”⁵ 

Educators acknowledge that biomechanics and body alignment are inextricably linked to violin technique. Dr. Vanessa Mio, violin professor at the University of Windsor, explains that poor posture can lead to “a lack of body awareness, left hand tension, poor tone production, or shifting difficulties throughout the various stages of development.”⁶ Mio’s teacher, Mimi Zweig, emphasizes the importance of maintaining the feeling of the arms hanging from the ball and socket joint of the shoulders in order to support the violin and bow with relaxed muscles. She attributes intonation issues to excessive arm tension, which affects both shifting and left-hand balance. Interestingly, Zweig also suggests that vibrato is a natural indicator of overall biomechanical efficiency, saying, “if the student can vibrate beautifully, it means that everything else in the body is working correctly.”⁷ 

Alexandra Türk-Espitalier, author of Musicians in Motion: 100 Exercises With or Without Instruments, also makes a compelling case that poor sound quality may be an indicator of musculoskeletal problems:

Like many violinists who grew up in the Suzuki method, I started violin lessons before I was 5 years old. By the time I was a teenager playing concertos, solo Bach, and Paganini caprices, my technique was deeply ingrained in my muscle memory through a process called proprioceptive learning. Franklin defines proprioception simply as how the mind and body perceive movement. This includes our kinesthetic sense and senses of balance, muscle tension, gravity, effort, and position.⁹ While playing the violin, your body receives feedback from proprioceptors responding to the feel of the fingers on the strings and the bow, the instrument touching your jaw, neck, and shoulder, the arms moving from the shoulder joints, and a vast number of other sensations. Lynn Helding, author of The Musician’s Mind: Teaching, Learning, and Performance in the Age of Brain Science, explains that this proprioceptive information informs the movement patterns required to make music and is continually reinforced through practice. However, Helding cautions that “just because it feels good does not mean it produces a desirable sound or a healthy use of the body. Motor learners who struggle to undo entrenched and harmful muscular patterns are up against this paradox and generally cannot guide themselves out of a movement rut but must seek objective help from a teacher.”¹⁰ As such, we must acknowledge that the professional violin teacher plays an essential role in addressing and preventing musculoskeletal issues in the violin studio. 

A brief disclaimer: violinists experiencing pain should consult first with a medical expert to diagnose symptoms and determine a plan for rehabilitating PRMI. Many playing-related injuries are movement-related rather than medical (in other words, do not require surgery), and working in collaboration with a skilled performing arts medicine practitioner, bodyworker, movement educator, and/or physical therapist can resolve many issues.¹¹ My own chronic shoulder injury was exacerbated by misalignments and restrictions in my pelvis and ribcage, which have begun to rehabilitate due to my work with a Franklin Method teacher. Fortunately, there are many different movement education modalities and somatic disciplines available to musicians today: Alexander Technique, Body Mapping, Feldenkrais, the Franklin Method, Timani courses, Pilates, and yoga, among others. But, alarmingly, a 2012 survey of Australian orchestral musicians found that half of the participants who had previously experienced an injury as a professional continued to play with an unresolved injury.¹² It’s important to consider why injured musicians may struggle to see results: 

1)  It can be difficult finding the right treatment or modality to address musculoskeletal issues as the process is highly personal and individualized. A movement modality like Alexander Technique may resonate with one musician but not another. English cellist Matthew Barley saw 18 doctors and physiotherapists after suffering a career-threatening shoulder injury before ultimately working with Wimbledon tennis club sports physiotherapist Joanne Elphinston, who helped him rebuild his musculature and cello technique by prescribing small low-impact exercises following a comprehensive analysis of the effects of 35 years of cello playing on Barley’s shoulder muscles.¹³

2)  Not every musician has the financial resources or is in a geographic area where they can work with skilled performing arts health professionals or movement educators and may be limited to working with professionals who lack specialized training in musicians’ injuries. Occupational therapy researchers Christine Guptill and Matthew Bruijn caution that physiotherapists and health professionals often utilize a wide variety of treatment techniques with variable success that may not accurately address the musician’s needs, noting that “many unfamiliar professionals recommend upper limb strengthening exercises when strength is often more than adequate.”¹⁴

3)  Not considering the mental side of injury rehabilitation. Guptill and Golem acknowledge that ignoring the mental and emotional aspects of injury may result in the musician failing to comply with or even dropping out of the treatment plan. Ultimately, they fear musicians will be reluctant to seek treatment in the future when injured.¹⁵ Violinist and musicians’ coach Sarah Whitney advocates for greater awareness of the mental aspects of injury, attributing her adoption of a mindfulness practice and working with a psychologist to her ability to manage pain and move forward from a chronic hand injury.¹⁶

4)  Failing to account for unhealthy movement patterns and areas of tension specific to playing when dealing with an overuse injury. Musicians may be encouraged to take time off to rest and recover from overuse injuries only to become re-injured once they return to playing full-time. Guptill and Golem observe that “simply taking a break from an activity that has caused physical problems does not address the ergonomic and biomechanical causes of the problem, and therefore the musician is more likely to have a recurrence in the future.”¹⁷ For violinists, a common ergonomic cause is setup (the combination of chinrest and shoulder supports used to hold the violin). An ill-fitting setup can cause severe neck and arm tension over time, but attempting to change equipment without identifying problematic movement patterns may exacerbate the problem. 

Which brings us back to the violin teacher. Instructors provide fundamental knowledge of posture and technique, setup recommendations, practice strategies, and mental skills for performance. Incorrect, incomplete, or misapplied information in any of these areas may eventually lead to students developing overuse or other musculoskeletal injuries during school or later in their careers. It is essential not only to provide students with biomechanically sound foundations of technique but to prioritize retraining movement and motor skills to fix longstanding problems with playing, a process known as remedial pedagogy.

Dr. Vanessa Mio explains that through remedial pedagogy, students gain “an understanding of their conditioned motor responses and rewire neurological pathways and actions to increase their overall performance ease, musical expression, and pedagogical knowledge.”¹⁸ To help their students play with freedom, ease, and healthy technique, teachers must develop a keen understanding of anatomy and biomechanics and be able to diagnose instances of excess tension and inefficient movement in their students’ playing. But most importantly, a skilled teacher must communicate clear instructions for the student to perform the movement with greater efficiency and kinesthetic awareness. Helding asserts that the “successful transference of any physical technique from teacher to student, be it in the realm of athletics, dance, or music, ultimately hinges on the ability to impart a motor skill from teacher to student.”¹⁹[19] In other words, how violin teachers teach technique and movement matters as much as what they teach. 

I want violinists to feel empowered to take a more active role in reducing pain and fatigue and finding more effortless ways to play the violin. I’m really looking forward to sharing some of my dissertation research this fall on motor learning principles and science-backed methods of communication that violin teachers can use to more effectively help students translate information about healthy violin technique, biomechanics, and alignment into physically efficient movement while playing. I believe this has serious implications not only for how we teach technique in the violin studio but also how we equip students to be their own best teacher in the practice room. Learning to move mindfully with an understanding of functional anatomy has changed my own approach to playing and teaching. It’s helped me find student-specific solutions to technique problems, show students how to release tension and find greater ease on the violin, and given me hope of playing pain-free for the first time in years. It’s imperative that we reassess how we teach quality movement in the violin studio and prepare our students for future success. 

Notes: 

1. Bronwen J. Ackermann, and Roger D. Adams, “Perceptions of Causes of Performance-related Injuries by Music Health Experts and Injured Violinists,” Perceptual and Motor Skills 99, no. 2 (2004): 669, https://doi.org/10.2466/pms.99.2.669-678. ↩︎
2. Eric Franklin, Dynamic Alignment Through Imagery, 2nd ed (Champaign, IL: Human Kinetics, 2012), 38 and 43. ↩︎
3. Ibid., 44. ↩︎
4. Ackermann and Adams, 673. ↩︎
5. Brenda Brenner, “Reflecting on the Rationales for String Study in Schools,” Philosophy of Music Education 18, no. 1 (Spring 2010): 47, https://www.jstor.org/stable/10.2979/pme.2010.18.1.45. ↩︎
6. Vanessa Andrea Mio, “The Need for Remedial Pedagogy in Undergraduate Violin Instruction: A Case Study of Postsecondary Instructors’ Perceptions” National Association for Music Education 37, no. 3: 37 (2019), https://doi.org/10.1177%2F8755123319826243. ↩︎
7. “The Remedial Process: An Interview with Mimi Zweig,” interview by Vanessa Mio, American String Teacher69, no. 4 (November 2019): 31, https://doi.org/10.1177%2F0003131319871453. ↩︎
8. Alexandra Türk-Espitalier, Musicians in Motion: 100 Exercises With or Without Instrument,  trans. Alexandra Türk-Espitalier and Christine Wendel (Frankfurt, Germany: Musikverlag Zimmerman, 2016), 128. ↩︎
9. Franklin, 68. ↩︎
10. Lynn Helding, The Musician’s Mind: Teaching, Learning, and Performance in the Age of Brain Science(Lanham, MD: Rowman & Littlefield Publishers, 2020), 129, http://ebookcentral.proquest.com/lib/byu/detail.action?docID=6012342. ↩︎
11. Heather J. Buchanan and Terrence Hays, “The influence of body mapping on student musicians’ performance experiences,” International Journal of Education & the Arts 15, no. 7 (September 3, 2014): 4, http://www.ijea.org/v15n7/. ↩︎
12. Bronwen J. Ackermann, Tim Driscoll, and Dianna T. Kenny, “Musculoskeletal Pain and Injury in Professional Orchestral Musicians in Australia,” Medical Problems of Performing Artists 27, no. 4 (December 2012): 183, https://www.researchgate.net/publication/233941573_Musculoskeletal_Pain_and_Injury_in_Professional_Orchestral_Musicians_in_Australia. ↩︎
13. Ariane Todes, “Matthew Barley Reveals How a Skiing Injury Forced Him to Rethink His Playing,” Strad, January 2009, http://search.ebscohost.com/login.aspx?direct=true&db=f5h&AN=35922402&site=ehost-live. ↩︎
14. Guptill, Christine and Matthew Bruijn Golem, “Case Study: Musicians’ Playing-related Injuries,” Work 30, no. 3 (May 2008): 308, http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105805165&site=ehost-live. ↩︎
15. Ibid., 307-308. ↩︎
16. Sarah Whitney, “What’s the Connection Between Mindset and Musicians’ Pain?,” Sounding Board, 21cm.org, January 2019, http://21cm.org/magazine/sounding-board/2019/01/03/whats-the-connection-between-mindset-and-musicians-pain/. ↩︎
17. Guptill and Golem, 307. ↩︎
18. Mio, 39. ↩︎
19. Helding, 98. ↩︎