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Play Without Pain: Repetitive Use Injuries and What To Do About Them

Brad Howland

Brad Howland

Many trombonists (and other brass players) are in pain. We suffer numerous ailments: wrist and arm pain, tendinitis, shoulder problems, neck strain, and chronic upper and lower back pain. In physiotherapy, our complaints are known as “Repetitive Use Injuries,” or RUIs.

What often happens is that when we get into our late twenties or early thirties our bodies start to rebel against those many years of practice while holding a heavy piece of metal in one rigid position with the left arm. The problem is made worse by the stress of maintaining high standards and the extra tensions this stress brings to the muscles. Although brass RUIs are usually not as career-threatening as string RUIs, we can still encounter enough pain to take the enjoyment out of playing.

We have to think of ourselves as athletes. Runners prepare for a 10 km race by stretching and jogging to warm up. These days it is also common for them to complement their training with other sports such as cycling. Similarly there are alternate activities we can do to help our bodies and minds cope with the stress.

My own experiments with the following activities eliminated the pain that bothered me for about seven years. I don't believe any one of them alone did the job. What was needed was a holistic approach. We need to examine all aspects of our lives and try to make the small gradual changes that lead to success.

Physiotherapy

The conventional Western approach to healing the body has come a long way in the last 20 years. There are several clinics in Canada that specialize in the problems of musicians. They treat acute pain as a sports injury using some form of “RICE” (Rest, Ice, Compression, and Elevation). Then a variety of stretching and strengthening techniques are employed. Weight-lifting (with free weights) is by far the most common alternate activity used to relieve chronic pain. Braces, ultrasound, and laser technology can also be used.

Physiotherapy trys to isolate one cause and treat it, when there may in fact be other non-physical causes. We need to treat the mind, body, and spirit holistically. Although the body's pain may manifest itself in a particular location, the real problem is often found in seemingly unrelated areas. For example, meditation can help relieve back pain. However, there is no doubt that strengthening exercises are extremely beneficial.

When playing any brass instrument, there are two problem areas that must be dealt with:

First of all, we tend to use our arms repetitively out in front of our bodies. The muscles in the front of the shoulders and chest become very strong, and those in the back of the shoulders and upper back become very weak. Strong muscles get shorter, while weak muscles lengthen. This imbalance can cause pain in the arms, chest, shoulders, neck, or upper back. The remedy is simple – stretch the muscles in front and strengthen the muscles in back. Build up the area so that other muscles can relieve those that are taking the strain.

One way to stretch the muscles in front is to stand at a door jamb or the corner of a wall. Grab hold of it with the right hand at arm's length, about shoulder height. Rotate your body to the left until you get a stretch in front of the right shoulder. Hold it for awhile, until the muscles loosens off, then increase the stretch slightly by looking down and over the left shoulder. Then reverse the stretch for the other shoulder.

To strengthen the muscles in back you can use a small dumb-bell. Lie down on your side, holding the weight in your upper hand with the elbow at a right angle, and rotate the weight up and down. Then hold it in your lower hand and rotate. Lie down on your other side and reverse the exercise. If the dumb-bell is too awkward to carry around, a piece of rubber tubing works very well, and you can put it in your pocket. There are several exercises you can do—for more information, please consult a physiotherapist.

The second major problem associated with playing a brass instrument arises from sitting for long periods of time. Sitting in a conventional chair is a pretty hazardous thing to do. Most chairs are not designed very well and cause bad things to happen. For one thing, blood pools up in the legs, away from the brain, causing lethargy (I can feel this right now, as I sit at the keyboard writing this). Also, the calf, hamstring, and lower back muscles bunch up and get shorter, with far-reaching effects.

Perhaps now is a good time to tell you my story. When I was in university I did a lot of running. I ran races, usually 5-10 K's, and even a marathon. However, by my early thirties I was in trouble. I had shooting pain in my hips and down the side of my legs, knee problems, and pain in the arches of both feet. Along with the running difficulties, I endured a lot of pain related to playing trombone. My upper back was killing me, and I had pinching pains up and down my left arm. Then, when my first child was born, I experienced the low back pain that most new fathers go through, the result of slinging baby around in a car seat. I was a wreck!

Finally, a good friend showed me Three Fabulous Exercises. These exercises wiped out all the problems I just told you about. I have no doubt that they saved my career, and improved my life a great deal. I don't hurt any more. I've been free of pain for 3 years, and I can run again! Although I haven't started racing yet, just yesterday I did an 8 K run.

I'm going to share these with you, because I think they are crucial for every musician to do. Remember, most of our pain comes from long term sitting, which tightens up the lower back. Consequently, these exercises stretch and lengthen the lower back. The lower back is a pivotal spot that effects the entire body. You must do them exactly right, so it's probably a good idea to print this page out for reference. You should do them every day. They only take about 15 minutes, but if you find them boring, I've included some variations.

Three Fabulous Exercises

Here are three exercises, with variations, that will go a long way towards helping you play without pain.

  1. Lie on your back with bent knees and feet flat on the floor. Lift the right leg and cross it over the left knee. Place your arms straight out from the body with palms down. Turn your head to look over your left shoulder. Now, rotate your legs and hips to the right (away from the direction you are looking) until you feel a gentle stretch. Hold 20-30 seconds.

    Now turn your head to the right and rotate to the left. Hold for 20-30 seconds.

    Next, reverse the legs. Crossing your left leg over the right, look to the right shoulder, and rotate to the left.

    Finally, look to the left and rotate to the right.

    Variation: lie on your back with bent knees and feet flat on the floor. Lift the right leg and cross it over the left knee. Place your arms behind your head with elbows as close as possible to the floor. Use your right leg to pull the left down and rotate to the right. Hold for 20 seconds. Reverse.

  2. For this exercise you need a long belt or towel. Lie on your back with legs extended. Lifting up the right leg, wrap the belt around your foot. Put the leg down and hold onto the ends of the belt with your right hand. Place your left arm out to the side, with palm down. Look to the left. Pull the right leg up and, at the same time, to the right (keep your knees straight and left leg on the floor). Hold for 20-30 seconds.

    Now take the ends of the belt in your left hand, and place your right arm out to the side, palm down. Look to the right. Pull the right leg up and, at the same time, over the left leg. Hold for 20-30 seconds.

    Next, reverse the exercise. Lift up the left leg and wrap the belt around your foot. Put the leg down and hold onto the ends of the belt with your left hand. Place your right arm out to the side, with palm down. Look to the right. Pull the left leg up and, at the same time, to the left. Hold for 20-30 seconds.

    Finally, take the ends of the belt in your right hand, and place your left arm out to the side, palm down. Look to the left. Pull the left leg up and, at the same time, over the right leg. Hold for 20-30 seconds.

    Variation: Lie on your back with legs extended. Lifting up the right leg, wrap the belt around your foot. Put the leg down and hold onto the ends of the belt with both hands. Pull the right leg straight up (keep your knees straight and left leg on the floor). Hold for 20-30 seconds.

    Variation: lie on your back with bent knees and feet flat on the floor. Place your arms straight down, palms on the floor and slightly under your buttocks. Extend your right leg down and rest it on the floor with straight knee. Stretch the right leg straight up, keeping your knee straight. Do this rather quickly, then slowly let the leg down to the floor (over 5-6 seconds). Repeat 5-10 times, then reverse and do the left leg.

  3. This is known as The Crunch. Lie down on your back beside a couch (or chair). Place your lower legs up on the couch, with knees bent and buttocks against the bottom of the couch. Put your hands behind your head. Curl your head, neck, and upper back upward towards your knees. You don't have to touch your knees. You benefit a great deal even going up 20 degrees. Work up to at least 20 repetitions.

    Variation: The Curl. Lie on your back with bent knees, feet flat on the floor, and hands behind your head. Lift both legs up together, keeping the knees bent. Curl your head up to touch your elbows to your knees. Work up to 20 repetitions.

    Variation on The Curl: Lie on your back with bent knees, feet flat on the floor, and hands behind your head. Lift both legs up together, keeping the knees bent. Curl your head up to touch your right elbow to your left knee, then your left elbow to your right knee, etc. The motion is like riding a bicycle. Work up to 20 repetitions.

Meditation

There are many different kinds of meditation. What they all have in common is the focusing of the mind on one thing. When the mind wanders and unwanted thoughts arise, it is gently brought back to the object of contemplation. For example, simply listening to music can be a form of meditation.

One meditation I often use is called “following your breath.” Sitting in a comfortable but upright position (so you don't fall asleep) focus your awareness on the tip of your nose and the air entering and leaving your nostrils. I get a wonderful feeling of peace and relaxation which can last the whole day. This is a great, natural method for dealing with performance anxiety.

Alexander Technique

F. M. Alexander was an English actor back in the days when long orations were popular. His career ended when he found himself suddenly unable to speak on stage. Examining himself carefully in mirrors, he saw that he had the habit of tightening his neck and pulling his head down and back, which affected his entire posture. He couldn't fix this by consciously trying not to do it, because his subjective feelings of good posture were unreliable, and only with the objective feedback of the mirrors was he able to improve his body alignment.

Looking around, Alexander noticed that most people use poor posture when performing everyday activities like sitting, standing, and walking. He therefore founded a school in which he utilized hand gestures and mental directions to teach better balance and posture. His students have gone on to teach the Alexander Technique around the world, and it has many applications for musicians. If you use your body efficiently and effectively you will have fewer problems with Repetitive Use Injuries. For more information or to find a teacher in your area, visit The Complete Guide to the Alexander Technique.

Yoga

There are many different yogas, but the most familiar to Westerners is Hatha, or Yoga of Postures. Please see the bibliography for some good textbooks. Yoga is great for musicians. It is, after all, an integrated system of cleaning, purifying, stretching, and strengthening the body that is thousands of years old. Christian Lindbergh practices yoga. Yehudi Menuhin was another famous practitioner.

Be careful! These are powerful poses, and because they are static it is easy to misjudge and go too far. Injuries are common, particularly with exercises that hyperextend (arch) the back. Only go to the point of a gentle stretch. You should stretch to feel good, not to look like the yogi in the pictures. If you have a history of lower back problems, consult your physician before starting a Yoga program.

Japanese Martial Arts

The martial arts stress harmonizing with your attacker's energy, merging with it and turning it against him. My experience is with Aikido, the “way of love and harmony.” Practicing Aikido tended to inject this philosophy into my life and changed the way I interact with people.

Another trombonist I corresponded with said that he never would have made it through a music degree without Taekwondo. If you take up a martial art, you may find yourself moving beyond the boundaries of your ego and working with the other musicians towards a common goal, rather than dominating the proceedings with your own ideas.

Other Activities

Other activities mentioned by trombonists as beneficial are self-hypnosis, prayer, biofeedback, and working with a chiropractor.

Aerobic exercises such as running, cycling, and hiking are very important. Playing a brass instrument takes a certain physical vitality, which requires good overall health.

Hanging out on a beach, staring at a starry sky, or just plain “loafing it” are all ways of putting things in their proper perspective. Even with all of our wonderful time-saving gadgets we all seem to work so hard (perhaps to pay off the gadgets). The way I see it, I took up the trombone to have fun, and to avoid working for a living!

Brad Howland is the Principal Trombonist of the Victoria Symphony Orchestra.