If you’ve been keeping up with the posts this week, you know that Janet Horvath has a wealth of expertise and experience to share in the area of injury prevention and recovery. She has kindly agreed to take specific questions from Music Matters Blog readers and answer them in a post next week. You can either leave your question in the comments below or e-mail it to me. I’ll compile all of them and send them to Janet, then will post her answers next week when I announce the winner of the drawing for her book, Playing (Less) Hurt. This is a great chance to have an expert answer your injury-related questions!

I am pleased to welcome Janet Horvath, author of Playing (Less) Hurt, to Music Matters Blog today to talk a little bit more about injury prevention and the role it should play in our teaching.

1. You come from a very musical family and began playing at a young age. Can you tell us when you first became aware of the importance of proper body use and injury prevention as a musician?

As a young teenager I remember frequently getting lazy with my posture. During high school orchestra rehearsals I would lean back and slump in my seat out of boredom or disinterest perhaps. Soon I experienced daily back -aches. I was really puzzled. Why did my back hurt so often? I, like other young, people didn’t mention it to my parents or teachers. It took me a while to figure it out but I did realize that it was associated with my playing posture. As soon as I sat up properly my back-aches went away. That was the beginning of my awareness, I think, although I didn’t know it at the time. Years later, when I became a college student of the great pedagogue Janos Starker, I wanted to be the best Starker student who ever lived! So I locked myself in a practice room (not admitting that I was also trying to escape from loneliness – I was away from home for the first time in my life). Soon my left arm started to hurt. I believed erroneously that if I played through the pain I’d be a better cellist…right? I continued my rigorous practicing. Soon my arm throbbed and I could no longer deny that I had hurt myself. I had let myself get to the point that I couldn’t use a knife and fork or turn a doorknob, let alone play!  I could do little with that arm, nor play for three months, all the while thinking that my life was over. When Mr. Starker returned from his concert tour that fall, I was so fearful of admitting to him that I was injured. To his credit, he hid his horror quite well! From that day, we began to rebuild my technique from the ground up, eliminating any tension and any awkward postures. It took a good six months to slowly get back in shape – with a new approach – playing with ease.

2. What has changed in your own practicing and playing since you experienced your injury and went through the rehabilitation process?

I have developed a third eye! When I am playing I am always thinking about how I can make it easier for myself. I know that playing without tension, being fluid in my movements, and relaxed, will only help me play with more expression and passion. I avoid playing if I feel an ache or pain. I stop and analyze what I might be doing to cause this. I try to take it easy if I am tired or very stressed. I always warm up. I always take breaks – 10 minutes per hour is a good guide. When that is not possible, say in an orchestra rehearsal, I have developed my Onstage Tricks™ – small moves that can alleviate tension even during performance to avoid risking injury. I vary my repertoire in my practicing so I don’t get “stuck” on one particularly challenging passage or technique. I am always aware that I am an athlete and my body does have its limits.

3. Is there a relationship between injury prevention and artistry in playing?

Making music with passion and artistry, at its best, requires us to be able to “lose” ourselves in the piece of music we are interpreting. It is very difficult, if not impossible, to play with ease and with a beautiful interpretation when we are in pain or so fatigued that all we can think about is getting through a performance. An athlete’s performance is compromised if they are hurting and so is ours. Make playing easy for yourself! When we can play tension free, and with fluidity then we are able to really touch our audiences with our music.

4. Teachers have a limited time with their students each week. How can we best utilize that time to help our students learn and practice effective injury prevention principles?

I think it is essential to include these techniques in each lesson so that it becomes ingrained in students. First, I would suggest a few minute warm up period at the beginning of each lesson. Few youngsters really know how to warm up, mistaking technical exercises for warming up. I have several suggestions in my book, but suffice it to say start not too slow, not too fast, not too high, and not too low i.e. in the medium range of your instrument at medium tempi gentle and easy. I urge teachers to take time in the lesson to uncurl arms and wiggle, to alternate standing and sitting positions if possible, and to spend time discussing a practice plan that varies repertoire. Teachers should be open about the possibility of injury and have an open approach so that a student feels that they can talk about their playing and hopes and dreams, as well as any issues of pain.

5. It seems like the best way for teachers to effectively work with students, especially as it relates to injury prevention, is to be so well-educated and aware of the root causes and symptoms that we can recognize them in our students and be proactive in addressing them. Do you agree? How do you recommend that teachers go about doing this (with reading your book, of course, being at the top of the list!)?

So true! I think there have been generations of teachers who have had no injury prevention training themselves, so they are at a loss when a student becomes injured. Today, musicians play longer hours, and they play more difficult repertoire with increasingly difficult challenges at younger ages and at higher levels. Hence, injuries are on the rise and we cannot get away with technical and postural imperfections. Teachers must learn how to instill injury prevention as a mindset in their students (and yes my book covers quite a gamut of suggestions and information, as well as resources for further help).

6. Any additional comments?

I want to emphasize that several injuries may present themselves with similar symptoms. It is essential when there is a persistent problem not to self-diagnose, but to seek expert professional help. There are many Performing Arts Medicine Centers springing up all over the country. These medical professionals know the challenges of playing an instrument. The sooner you get a diagnosis and you are treated, the better chance there is that there can be total recovery.

If you haven’t already done so, be sure to enter the drawing to win an autographed copy of Janet’s book, Playing (Less) Hurt.

Just to give you even more of an idea of the helpful information you’ll find in Playing (Less) Hurt, the book I reviewed yesterday, here are two brief excerpts that Janet has given me permission to share:

10 POTENTIAL FACTORS CONTRIBUTING TO OVERUSE

1. Body size, build.
2. Conditioning.
3. Muscle imbalances due to the demands of playing the instrument.
4. Fatigue.
5. Joint laxity.
6. Stress levels.
7. Misuse: poor technique, poor habits and/or poor posture.
8. Abrupt changes or increases of schedule, length of practice, instrument type or weight.
9. Style of playing and lifestyle choices.
10. Your equipment setup.

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 or slam or squeeze down keys?
• 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 a very large, heavy or very resistant instrument?
• 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 neglect to warm-up?
• 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?