This past fall, I had two students who were experiencing pain while they played their instruments in class. I took some time in class to describe how students can injure themselves playing. The first reaction of several students was to laugh. They thought it was ridiculous that people could injure themselves playing an instrument. To help the students see how this can happen, I used a point, recently illustrated by Janet Horvath at the MNSOTA Fall Clinic on October 21, 2010, that when we play music, we repeat the same motion thousands of times. Injury from playing a string instrument does not come from one large gesture or motion, but from the repetitive nature of what we do. One way to illustrate how repetitive injuries can happen is to have students hold their arms in the air for 60 seconds (without instruments) or have the students repeat the same two or three notes over and over again for 60 seconds. Their arms begin to get tired - now compare this to playing for 60 minutes. This made a lot more sense to the students.

Of course, the first things I tell my students to do to avoid injury is to set up how they play their instruments:

Instrument balanced - Violinists usually use some form of shoulder rest that is adjusted to fit their body sizes and shapes. I have several different brands on hand for students to try out in class before they buy them. Personally, I like Kuhn rests because they are adjustable; however, they don't work for all students. Other brands that help students with extra long necks are Everest and Bon Musica. Some students with shorter necks do better with a sponge or PlayOnAir. For basses and cellos it means adjusting endpins and making sure the instrument is in proper position.

Relaxed bow hold - Make sure students do not squeeze the bow or stick.

Chair type - I am very fortunate to have Wenger posture chairs in my classroom. Sometimes when it is close to a concert for another ensemble, we need to leave the good chairs on stage and use folding chairs in class. The students can really feel the difference and try to get to class first to get whatever Wenger chairs are left. Having a good chair can help avoid back pain and slouching.

Posture - It might seem more comfortable to slouch in the chair, but students notice more back problems and arm problems when they are not properly balancing their weight. Students should be able to stand up at any time when seated. Sometimes we do this two or three times during class to check posture.

Stand height and placement - I sometimes see students doing individual practicing with music on their laps or on the floor or table. Having music on stands at the correct height is very important. Again, it is not just playing like this once, but over and over again for 30 minutes to an hour that can cause injury.

Another way to help teach students to avoid injury is to provide the proper structure to rehearsal:

Warm-up & stretch - Warming up and stretching during and after rehearsal are important habits to teach students. It is important to have students play long tones with their bows to warm up their bow arms and use slow scales to warm up their left hands. One of my favorite resources for stretches is Janet Horvath's Playing (Less) Hurt.

Take a break - During rehearsals it is important to find time to stretch and rest muscles. For a violinist, it is important to uncurl the arm when not playing. Setting down the bow can help to rest the bow hand and arm when having a break. As a director, it is important to work with individual sections in small chunks and move around the group so that different students are getting time to rest during rehearsal.

Stop when it hurts - In our culture we have heard "No Pain, No Gain" in reference to physical exercise. However, in playing music pain does not lead to gain, but in fact can prevent students from playing correctly or even lead to long term injuries that can end their playing altogether. I tell students to stop playing if they experience pain, and analyze what they might be doing to cause the pain. If students have injuries that impact their playing, I allow them to take a break during class. Students can still mentally practice the music with us and follow along. Many times a student can play for a few minutes, take a break, and then play again later.

Sometimes students are injured doing other activities, but find that it impacts playing their instruments. This year, a member of the football team and violinist in orchestra had an injury from football practice that was irritated when he played, especially when playing full bows. My first advice was to see a doctor who specializes in muscle injuries, and I also loaned him a copy of Playing (Less) Hurt. He went to the doctor and found he had a Rotator Cuff injury. In Playing (Less) Hurt there is a whole section specializing in Rotator Cuff injuries that explained what is happening when he plays that can impact the injury. The book also had excellent advice on how to stretch the muscles for this type of injury and how to help get back to playing. During class, he has learned to take breaks when his arm is hurting. He also has learned to practice using left hand only, work on ear training, and do mental practice.

Especially with students who are driven to succeed on their instruments, it is important to stress setting practice goals and plans to help avoid injury. Setting a timer during practice sessions and balancing less stressful technical work with more intense technical practice can help to keep practice productive, yet not aggravate or create injuries.

Talking with students about the possibility of injuries and how they occur is important. It is also important to take time every day to remind students to take care to avoid injury. Having resources available, such as a variety of shoulder rests, books and articles, and proper chairs, are ways we as teachers can help our students make good choices. We also need to make sure we are modeling good posture and physical health to our students by how we organize rehearsal time and how we demonstrate on instruments in front of students.