Category Archives: Musician’s Health

The First Three Steps You Can Take For Resolving Chronic Pain And Injury

close up photo of a man having a neck pain
Photo by Kindel Media on Pexels.com

After recently reading some rather disheartening discussions on various social media platforms, where professional musicians were discussing the “inevitability” of chronic pain and injuries, I thought I’d offer some (hopefully) helpful thoughts.

As a certified Alexander Technique teacher and musical practice coach, I have a good amount of experience helping musicians effectively address such issues. I’d like to offer up what I think are the three most important steps you can take if you’re struggling with chronic pain associated with playing your instrument.

Step One: Believe that you can improve.

This is one of the most commonly counterproductive assumptions many musicians I encounter have about discomfort, chronic pain and chronic injuries associate with making music.

Chronic pain conditions associated with a repetitive activity like playing a musical instrument are typically caused because of the interplay between two things:

Overuse, and misuse.

You can dramatically improve upon both of these variables. It’s a matter of choice. And that choice starts with belief. If you believe you can’t improve upon these things, then you’re right. But only because your disbelief stops you from taking action.

So start by believing things can get better. (Because they most certainly can!)

Step Two: Do some research.

If you’re at any stage of chronic pain or discomfort, take some time to research and understand the science behind your struggle. Try to find simple, but relevant information on the physiological framework that defines your condition.

This starts with getting a medical diagnosis from your primary care physician. Your condition might not be one that can be effectively addressed from a medical point of view, but it is always a good place to start. Even if you can’t get a definitive diagnosis for your condition, you should at least make sure that it’s not because of a measurably pathological element (e.g. neurological, metabolic, etc.) that truly needs immediate medical attention.

From there, you can do some extra research on your own.

For example, if it appears you might have the beginning of Carpal Tunnel Syndrome, first understand (from an anatomical and physiological perspective) what the carpal tunnel actually is, and what you might be doing in your movements to cause the inflammation that leads to the Syndrome.

The better you understand the “mechanical principle” of what is causing the dysfunction, the better equipped you are to choice the best course of action to improve.

And part of that course of action involves finding the appropriate professional help, if needed. So take time to understand the “scope of practice” that various practitioners adhere to, and decide which practitioner(s) might be able to help.

There are many professional resources these days to effectively address even the most stubborn chronic pain issues. Skilled movement experts (like Alexander Technique, and other somatic education teachers, physical therapists, etc.) and skilled manual therapists (like neuromuscular massage therapists, chiropractors, etc.) are plentiful.

Then it’s time to do some research to find the specific individual(s) best suited to help you. Look for recommendations from others. Read reviews. Ask questions.

Also, take some time to research the potential “environmental” factors (e.g., equipment, lighting, chairs, stands, props/supports, etc.) that can impact your condition.

Three: Take action

Once you’ve done your research, it’s time to go into action. Get an initial consultation with the appropriate professional(s). Make the specific environmental changes you’ve researched that seem to be most likely to impact you in a positive way.

After you’ve taken some action, make a conscious decision to reassess your choices. Give things a reasonable time to make an impact (sometimes changing these things takes a fair amount of time and patience), but be willing to recognize when something clearly isn’t working.

And if it isn’t working, do some more research. Ask more questions. Find another way.

Pain can be a slippery slope, in that the experience of pain is impacted by many variables. And there certainly are specific chronic conditions that seem to be impervious to any kind of help.

But most chronic pain and injury is most definitely improvable. Often significantly so.

Just remember the most important step in this process (step one). Believe that things can get better…

For This “Career Ending Condition”, There Is Hope

Around 25 years ago, I started noticing a deeply troubling change in my saxophone playing experience. Simply put, I would have days where I just couldn’t seem to get the fingers of my left hand to do what they could so easily and naturally always do before in order to express myself musically.

At first this was a phenomenon that seemed to come and go, but after about 5 years of this “come and go”, I fell rather immediately into a period of complete loss of control of the fingers of my left hand.

The strange thing was that my left hand worked just fine in any other activity…writing, using hand tools, cooking…activities that require a good amount of fine motor skill.

Yet the moment I even touched the keys on any of my saxophones, my fingers would curl up uncontrollably.

I got to the point where I couldn’t even hold the fingers of my left hand down onto the keys of the saxophone, much less play anything resembling music. I had to stop accepting any kind of work playing saxophone, as well as even just enjoying a rehearsal or jam session. I could no longer play. Simple as that.

To say that I fell into a deep despair would be an understatement.

It was after seeing a physician (a very good internal medicine doctor, whose specialty was in diagnosis), that I learned that I most likely had a form of focal dystonia. I went on to get a diagnosis from a neurologist to confirm this.

The term “focal dystonia” was something I’d never heard before. But the symptoms, this type of unexplained loss of skill specific to the act of playing music, was not unfamiliar to me.

I had encountered several other musicians over the years prior to the emergence of my condition who had similar experiences. In fact, one of my closest friends and musical colleagues, a highly skilled and highly accomplished trombonist, was experiencing this same phenomenon with his facial muscles and tongue.

So what is focal dystonia?

I think this definition by the Dystonia Research Foundation sums it up best:

“Dystonia is a neurological disorder that causes excessive, involuntary muscle contractions. These muscle contractions result in abnormal muscle movements and body postures, making it difficult for individuals to control their movements. The movements and postures may be painful. Dystonic movements are typically patterned and repetitive.”

Within the realm of focal dystonia, there are several sub-categories. For those whose dystonic symptoms only appear while engaging in a learned, skilled activity, the condition is referred to as task specific focal dystonia.

This includes things as common as “writer’s cramp” (though I suspect that lots of forms of writer’s cramp are not focal dystonia, but simply overuse, or misuse), to surgeons losing their “hand skills” only while performing surgery, to a condition in the sport of golf known as the “yips”, where the golfer shakes uncontrollably before a shot that is normally “easy” to make.

And within the of category of task specific focal dystonia, there is task specific musician’s dystonia, more commonly known as musician’s dystonia, or simply by its acronym, MD.

And to subdivide even further, there are generally two types of musician’s dystonia: hand dystonia and embouchure dystonia (“embouchure dystonia” includes the facial muscles, tongue, jaw, soft palate, sometimes neck muscles, and even respiratory structures).

The first thing you are told if you are diagnosed as having musician’s dystonia, is that there is no cure. There are a few medical modalities that can be applied (medications, botox injections, etc.), that might lessen the symptoms. But I’ve yet to encounter a musician who became permanently “symptom free” from these interventions.

This is in part, because the “mechanism” of the condition is still largely a mystery to medical science, and hence any kind of “cure” is not to be found.

For most musicians who get medically diagnosed as having musician’s dystonia, the advice is often the same: Switch careers.

Well that’s just something that’s not easily accepted by many musicians. It certainly wasn’t easy for me. In fact, I refused accept it.

For “serious”, life-dedicated musicians (whether professional or amateur), the idea of not being able to express ourselves freely, authentically and skillfully through music is tantamount to losing an essential part of what defines us, and what gives deep meaning to our lives.

So I was faced with my only option: work at making my condition better so that I could restore this essential part of my life.

My path was (and continues to be) long, and the learning (and more important, the “unlearning”) process was not a straight line. At first I tried to improve my symptoms by practicing more. Much more.

But the more I practiced, the worst my condition became.

Then I went in the other direction, deciding to take a break from playing saxophone completely in order to see if I would “forget” the old dystonic patterns.

After not touching the instrument for many months (and being at the point where I just couldn’t stand being away from it any longer), I painfully discovered that nothing had changed. If anything I felt even more “dystonic” and disconnected to the saxophone than ever before.

I tried massage, stretching, exercise, change of diet…just about anything I could to try, to alleviate my condition. Nothing seemed to work even in the slightest.

It wasn’t until I discovered the Alexander Technique that things begin to change. It was in my Alexander Technique lessons that I learned three very important things:

First, musician’s dystonia (like any focal dystonia) is a “whole body/whole person” reaction. It is something that affects the coordination of my entire physical (or more precisely, “psycho-physical) organism. As my general “use” began to improve (my quality of movement, balance, posture, attention, etc.), my dystonia symptoms became noticeably fewer and less intense.

Second, a big part of learning to improve my overall “use” was in developing the skill of conscious inhibition, i.e., the ability to keep an unwanted reaction in check. I learned that by simply “giving myself permission to stop” whenever I felt the rise of a dystonic reaction while playing my instrument made an immediate and remarkable improvement in my symptoms.

Third, I learned the importance of accepting my symptoms just as they were in the moment. In short, I developed the ability to stop “reacting to how I was reacting”. I discovered that I could observe myself more discerningly, more objectively and dispassionately. This was an empowering realization, and became emblematic of my emerging skills with conscious inhibition.

(I was so impressed with the efficacy of the Alexander Technique, that I went on to train to become a certified Teacher, and have been teaching since 2006.)

As I applied this work, I also started doing lots of studying, from neuroscience, to kinesiology, to anatomy/physiology, and more. I formulated lots of exercises, explorations and activities based upon my studies, and spent a good deal of time working things out.

My progress often seemed “two steps forward, one step back”, but that was okay. I’ll accept that ratio. My daily practice sessions transformed from frustration, despair and discouragement, to curiosity, exploration, discovery and delight. The process of improvement itself became deeply satisfactory.

Since then I’ve continued to improve my condition to the point where I can play saxophone now with the skill, confidence, connection and authenticity that gives me joy and satisfaction.

I’ve also had the opportunity to help some other musicians with dystonia to improve their condition, and it is for this reason that I’ve created a page on my blog dedicated to offering this help.

So if you have musician’s dystonia (or suspect that you do), please get in touch with me. I always proceed from a place of love, understanding and safety in addressing this condition.

And if you know a musicians that is struggling with musician’s dystonia (whether with the embouchure or hands), please direct them my way.

There is hope…

Clarifying A Common Misconception About “Tension” In Playing Music

On the first day of the semester in each of my classes at the performing arts college where I teach the Alexander Technique, I often ask this “trick” question:

“Is it possible to perform (music, acting, dance, etc.) free of tension?”

Typically, the majority of the class answers with a resounding “yes” (as they’ve come to believe that’s what they want, that’s why they’re taking my class).

But the answer to this question is simple: No.

It is impossible to move, maintain balance, breathe, or otherwise function on even the most basic level without some sort of muscular tension. This is not a matter of “opinion”. It’s a matter of fact. It’s part of our human design.

Even when you’re feeling completely “relaxed” there is a certain, necessary amount of postural tone in your body to help you counter gravity (even when you’re lying down.)

So why do so many of these students, themselves aspiring performing artists, answer “yes” to this question?

It’s simple. They think that “tension” is their enemy.

They think that all the problems they have with their movement, posture, breathing, voice, etc., would simply vanish if they could somehow eliminate “all the tension” in their bodies.

But it’s not as simple as that.

It’s not a matter of being “free of tension”, but rather, of recognizing and preventing what I call misdirected effort. It is this “misdirected effort” that is too often perceived and labeled generically as “tension”.

It is this misdirected effort that makes playing music (or engaging in any kind of performance activity) seem “difficult”, “tense”, “stiff”, “stuck”, “rigid”, “unnatural”, “labored”, “self conscious”, “unsure”, “unsatisfactory”, etc.

Okay, so what’s the problem trying to avoid any kind of “tension” when playing your instrument?

The most fundamental problem is that doing so can make you reluctant to sense and accept even the well-directed muscular effort that is necessary to play your instrument.

So as a musician, what might “misdirected effort” be for you?

I’d say it’s anything that you do habitually as you play your instrument that is not only unnecessary to the act of playing that instrument, but also interferes with your natural coordination and your skill.

It is working against the reality of your human design, rather than working in harmony with it.

Let’s look at this example of a fairly common habitual pattern of misdirected effort you might have if you were a pianist:

Whenever you move up or down the keyboard playing a rapid and/or powerful passage, you narrow and raise your shoulders while pulling your head down into your spine.

Now, you might still be able to play just fine doing that, but not because of what you do. That pattern of “effort” (raising/narrowing your shoulders, etc.) doesn’t help you to carry out your wish to play the passage.

In fact, all this misdirected effort in your head/neck/shoulders has a tendency to be an obstacle to the freedom necessary in your arms and hands to play the passage skillfully and expressively.

So in this case, you’re able to play the passage despite doing that (your habitual pattern of misdirected effort), not because of it.

But no matter which instrument you choose, the more you recognize and prevent patterns of misdirected effort, the easier it gets to play that instrument. (Not to mention safer, more consistent and more satisfying!)

So you can observe yourself with this simple question: “What am I doing that is not necessary to the act of playing my instrument in this moment?”

This question (simple as it is) is something that should never be answered definitively. and completely Rather, it is a way for you to explore and discover continual improvement and growth as a musician.

After all, something that seems “necessary” today might not seem so necessary after some days of exploration. Calling what you do into question as you practice is not that same as “doubting” yourself or your technique. It’s just a tool to open up possibilities.

Another good question to ask as you explore and call into question something that might seem like an habitual pattern of misdirected effort is: “What’s it like when I don’t do that?”

And as you ask that question, you might come up with other questions, like:

“Can I still get the sound that I want when I don’t do that?” (if not, why not?)

“How does not doing that affect my sense of time?”

“What changes favorably in my body as I don’t do that?” (or unfavorably?)

“Do I feel ‘undernergized’, perhaps ‘unable’ to play when I don’t do that?”

“Do I rely upon feeling this misdirected effort to ‘believe’ that I’m playing my instrument ‘correctly’?”

And so on…

Some of the more basic things to examine as you explore are:

Your head/neck/jaw relationship. (Is it rigid or free?)

Your shoulders/arms. (same as above)

Your knees (free to move, or “locked”?

Your breathing (noisy and “forced”, or dynamic but “easy and available”?)

Your eyes/gaze (fixed or mobile/dynamic?)

Your balance/connection to the ground (light and expansive, or heavy/compressive?)

(And again, as I mentioned above, anything you notice in your observations can be addressed with that first question: “What am I doing that’s not necessary…?”)

So in the end, “tension” is neither your enemy, nor your friend. It is simply something that takes place between your thoughts and your body. As F.M. Alexander (the founder of the Alexander Technique) stated:

“You translate everything, whether physical, mental or spiritual, into muscular tension.”

Tension is necessary for you to live, and for you to play music. Misdirected effort is not.

Five Checkpoints For Healthy And Efficient Practice

As I write this post, I can easily say we are living in “historic times”. Because of the current health crisis, people from all over the world are staying inside (thankfully!) much more than usual.

And based upon the significant increase in inquiries about my remote services and my e-books, I can also safely assume that musicians worldwide are practicing their instruments considerably more than usual, as well.

And that’s a good thing, perhaps a small silver lining to this cloud.

So I thought I’d share some very basic principles based upon the Alexander Technique, as well as my experience coaching musicians of all kinds (as well as my own experiences practicing saxophone and improvisation).

These are things to pay attention to that can better enable you to optimize your practice efforts, as well as help you avoid injury or strain from increasing your daily practice time.

I’ve narrowed the topic down to what I consider to be five of the most essential things you can take into account (i.e., five “checkpoints”) in the practice room.

These checkpoints serve as a quick, simple and comprehensive way to take care of yourself as you practice. Here they are:

1. Your head/neck relationship

In Alexander Technique jargon, the dynamic relationship of your head to your spine is called the “primary control”. F.M. Alexander discovered that this relationship is key to governing your overall coordination (hence, the word “primary”).

So as you practice, take a bit of time to notice what’s going on between your head and neck. Is your head balancing freely as you start to play, or are you stiffening your neck, perhaps pulling your head downwards into your spine?

If you allow your head to release upward into free and easy balance on your spine, you might also notice that your shoulders and arms become freer.

If you allow for it, this freedom will tend to spread throughout your body all the way down to your feet, gently encouraging you to release in your back, and unlock your knees and your ankles.

Think of your entire self as expanding into length and width as you play. This expansion is not rigid “posture”, but rather, is dynamic elasticity.

2. Your connection to the ground

Your connection to the ground both supports your head/neck relationship, as well as is influenced (for better or worse) by it.

Allow the ground (or if you’re sitting, the chair) to accept your weight, but don’t collapse downward to do so. Think of your body has having a light, easy and upward suspension that interacts dynamically and efficiently with the ground to counter the downward pull of gravity.

3. Your breathing

Whether you use air to make sound on your instrument, or not, breathing is essential to you coordination, poise, consciousness and power.

For the most part your breathing will “do itself” just fine if you let it. In other words, your brain knows just what to do to breathe optimally if your habits don’t interfere.

In short, think of your entire torso (especially your ribs!) as being free to move in all three dimensions (side to side, front to back, top to bottom) in order to produce the movements necessary for inhalation and exhalation. Don’t aim for anything that feels labored or unnatural.

4. Your external environment

No matter where you practice, always use your senses/attention to include the room you’re in.

This is a matter of allowing your senses to open up and reach outward. So listen for your sound out into the room (as well as hearing or “feeling” it close to you or even “inside” of you).

And let your eyes be free to see the room as well. Not in any kind of distracting way, but rather, as a way for you to get better oriented into your practice space.

If you tend to always close your eyes when you practice a particular thing, experiment with what it’s like to not do that, to actually let your attention be flexible enough to go inwards (towards you) and outwards (where your sound ultimately comes to life) at the same time. Think of your attention as being “inclusive and flexible”.

5. Your use of time

When I talk of “use of time” here, I’m really talking about time as a broad, multi-faceted subject.

There is “time” as it relates to how you play rhythms, meter and inflections. What you do with your metronome, or backing track or drum groove, etc. Because all of your coordination ultimately depends upon your perception of time (“pulse”), I encourage you to make time the most essential musical element whenever you practice, no matter what you’re practicing (even when working on your sound).

And then there is how you use your time to pause and redirect your attention/efforts while practicing a particular thing. It is never a waste of time to stop, notice and redirect. This is an essential tool of the Alexander Technique, and something that takes a good deal of discipline to implement (but it is so well worth it!)

As you learn to pause and redirect, you open yourself up to the possibility of discovery, change and growth.

And finally there is how you use your time to take care of yourself during your practice session.

Make sure your taking lots of breaks (lasting even just a few seconds between iterations of whatever it is you’re practicing, to 5 to 15 minute breaks during your practice session). Doing this will not only keep you healthier (avoiding strain and injury), but will also keep your attentional capacity fresher and more effective.

So enjoy your extra practice time. Use these five checkpoints from time to time during your practice session. Be safe, and stay flexible, curious and productive.

Clarifying A Common Misconception About Your Lungs To Help You Breathe More Optimally

Uploaded to www.sxc.hu for use.

Many of the chronic problems wind instrumentalists and singers encounter with breathing are due, in part, because of misconception.

In particular, misconception of the structure, function and coordination of the mechanisms involved in both natural (passive) and extraordinary (as in playing or singing) breathing.

I’d like to address and clarify a very common misconception here in this post: the size and location of the lungs themselves.

Let’s start by some of the things some musicians think they are doing with their air:

“I’m putting the air down there in my belly.” Or, “I’m placing the air down into my diaphragm.” And other ideas to this effect.

I won’t digress here about why it’s impossible to “place the air down in your diaphragm”, other than to say that the air you inhale never goes directly into your diaphragm.

It enters into your lungs. Simple as that.

The primary function of your diaphragm is to assist in changing the size and shape of your lungs to facilitate inspiration and expiration. It does this in concert with your intercostal muscles (the muscles between your ribs), as well as with other auxiliary muscles.

So where are your lungs, exactly?

Well, they’re higher up and further back in your body than you might have thought. Here’s a simple, animated video from the DVD entitled, Move Well, Avoid, Injury, to help you get a visual on all this:

As you can see, the air doesn’t actually go into your “belly”. The three-dimensional movement of your abdominal area is largely on account of the displacement of the abdominal content, because of the movements of the diaphragm and ribs (and other structures, as well.)

So what’s the possible downside of trying to “put the air down there in your belly”?

Well, in the simplest sense, by trying to do the impossible, you’re most likely also interfering with your natural, optimal breathing coordination.

Whenever I see a wind instrumentalist trying to “put the air into the belly”, I typically also see a stiffening up of the neck and shoulders, accompanied by a downward compression of the head on top of the spine, and a narrowing, or hollowing, of the lower back.

All this tends to prevent the ribs from moving freely enough to sufficiently (and efficiently) transform the internal dimensions of the thoracic cavity (the part of your body including, and inside of, your ribs) that facilitates the movements necessary for full and dynamic breathing.

So take a good look at the video I’ve posted here. Notice the size and the specific location of your lungs, along with the range of movements the lungs go through via the actions of the ribs, diaphragm, and other muscles. By clarifying this misconception, you might very well discover a new freedom, flexibility and fullness with your breathing that had been eluding you in the past. Enjoy!