Neck and Shoulder Pain in Musicians: Causes and Treatment
Playing a musical instrument is an emotive and artistic activity but is also physically demanding. Professional and amateur musicians often experience pain and injuries that limit their ability to play. Research 1 indicates that over 80% of professional musicians in orchestras experience pain and injuries that inhibit their ability to play. In contrast, younger musicians do not usually experience playing-related pain as they do not spend as much time on their instruments as tertiary students or professionals do. However, learning the principles of body care when younger can hopefully reduce pain and injuries as the musician progresses to higher levels of playing.
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This blog will cover:
- Common causes of neck and shoulder pain in musicians
- What neck and shoulder pain do musicians experience?
- Preventing neck and shoulder pain in musicians
- Treatment options for neck and shoulder pain in musicians
- Exercise series for musicians
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Common Causes of neck and shoulder pain in musicians
- High repetition of movement without adequate breaks or variety
- Non-ideal 'ergonomics' – the way the body interacts with the instrument
- Immature technique - normally with too much playing tension
- Inadequate recovery between playing sessions
- Reduced general fitness and postural endurance
Many instruments, especially strings, flute, and guitars are played with unnatural, imbalanced postures which cannot be changed. Therefore, it is crucial to recognise and minimize the effects of these postural challenges by ensuring your body has the capacity to hold postures for extended periods and you have an active recovery plan after playing.
What neck and shoulder pain do musicians experience?
Nearly every musician experiences muscular tension during or after playing. If left unmanaged this can lead to more inhibiting pain and even specific anatomical trauma that can be career-threatening. Musicians also tend to play through increasing tension, hoping it will go away with simple rest. However, if pain is present during play and lingers afterward, seeking help is essential to figure out why. Most musicians’ neck pain does not involve specific pathology but is a result of increasing and lingering muscular tension.
Neck tension can lead to reduced range of neck movement, can change the way you address your instrument and cause further problems in the forearms, wrists, and hands. Headaches an jaw tension are also commonly linked to neck tension. Musicians may be having treatment and doing exercises for pain further down the arms but have not addressed trunk endurance, shoulder strength, and neck tension. Likewise, solving neck or shoulder pain may involve analysing movement throughout the trunk, shoulders, arms and hands.
Preventing neck and shoulder pain in musicians
If musicians think like a sportsperson and respect the physicality of their craft, they can reduce neck and shoulder pain. An easy to remember approach is:
Condition2 – ensure you are generally fit and have good postural and muscular endurance
Prepare3 – warm up your body for playing (not stretching – that’s for after play)
Play – develop sound technique with minimal tension, plan regular breaks in practice, build up to pieces of higher intensity or speed, and listen to your body's messages!
Recover – stretch after playing, hydrate, eat, and especially sleep.
Treatment options for neck and shoulder pain in musicians
Many musicians are told they have tendonitis or bursitis of the shoulder, a facet joint injury in the neck, or some other specific pathology. However, approaching musicians' neck and shoulder pain as an overload problem requires identifying all the reasons the area in pain is overloaded. Expensive diagnostic tests trying to identify the exact structure causing pain rarely change the management strategy for the majority of musicians. Massage, dry needling, stretching, and manual therapy techniques can help relieve symptoms and can allow you to keep playing but will not solve why things are tight and sore.
Whatever the diagnosis of your pain, the treatment approach should include a graduated strength and conditioning program to improve your physical capacity for playing. This should address trunk strength, scapula (shoulder blade) stability, shoulder muscle endurance and neck muscle positional awareness and endurance.
Exercise series for musicians
One exercise series you can use to gradually improve your physical condition for playing music is the push-up. When you can comfortable do and control 15 move to the next stage. You can also gradual increase the depth of the movement within each stage before you are doing a full pushup in that position.
The Musicians push-ups series:
- Wall push-ups
- Incline pushups - (kitchen bench)
- Incline pushups - (end of the couch)
- Kneeling pushups
- Full bodyweight pushups
Conclusion:
Neck and shoulder pain can be debilitating and career-threatening for musicians. Rather than trying to find out exactly what is 'wrong' with the structures in the body, musicians should address their general fitness, postural strength and endurance, analyze technique to reduce playing tension, and ensure they are adequately recovering from the physical demands of playing a musical instrument.
If you’re a musician, visit us at PhysioTec and let David assess you and provide you with a personalised program for performing your best!
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Author
This blog was written by David Peirce, one of our senior physiotherapists who has over 30 years of clinical experience and a special interest in the Performing Arts, Sports and helping his patients return to the things they need and love to do. You can read more about Dave here.
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References:
- Musculoskeletal pain and injury in professional orchestral musicians in Australia, Bronwen Ackermann 1, Tim Driscoll, Dianna T Kenny
- Are music students fit to play? A case study of health awareness and injury attitudes amongst tertiary student cellists, Dale L. L. Rickert dalerickert@gmail.com, Margaret S. Barrett, and Bronwen J. Ackermann
- A systematic review of the effects of upper body warm-up on performance and injury, J Matt McCrary 1, Bronwen J Ackermann 1, Mark Halaki 2
- Effects of Physical Symptoms on Muscle Activity Levels in Skilled Violinists, J M McCrary 1, Mark Halaki, Bronwen J Ackermann