Tendonitis: avoid it with a body-centred approach
Tendonitis is that rather vague term for inflamed tendons that can hit musicians every now and again, causing havoc and a lot of distress. All musicians need to learn to use their body well and efficiently when playing their instrument and this can go a long way towards preventing the dreaded tendonitis. I thought I’d start by mentioning key issues that create problems for pianists so bear with me if you’re not a pianist, because there are strong correlations between all the instruments to some degree or another which I will clarify as I go along.
From the pianist’s perspective
What I have learned over the years, is that if pianists can have a good, free sitting position, their physical structure can support them in the way they need to play. These are some of the things I feel are important:
The stool needs to be the right height for each individual. The elbows need to be roughly level with the keys – it’s nothing to do with how tall or short a person is.
The pianist needs to be sitting on the front half of the stool so as to engage their core muscles and not their thigh muscles,
The pianist needs to be sitting free and upright, so their arms can hang freely at their side.
The next steps are to keep wrists, elbows and shoulders free and to find power in the fingers with the support of directed and focused arm weight.
I always start a piano student off by seeing whether they can hang their arm as a dead weight down by their side. I then lift their arm to see how they’ve done. This shows me two things:
Can the student allow their arm to be free and totally relaxed? Often they will tense up or lighten the arm and try to ‘help’ me when I lift it
How aware is that pianist of their body in general? The students who play sport, yoga or similar, or pianists who sing and who therefore are used to thinking of their bodies to produce a sound, tend to find this much easier than those who don’t.
Pianists who get tendonitis – and this is from my own personal experience not from any studies – usually tend to have either a tight wrist, outstretched hands that never free up even in easy passages, tightly held arms, or a combination of all three.
How these tensions impact other instruments
These issues may be specifically pianistic, but they apply to all instruments in one way or another. For example, I have seen a clarinettist who kept their fingers tight and outstretched on the keys resulting in shooting pains up and down their arms; a violinist who had a very long neck and needed an extremely high shoulder rest so that their left shoulder didn’t try to lift and meet the violin, resulting in excessive pain and tension in that shoulder; and brass players who had everything in place technically but had rock solid shoulders where they stored all their tension. Body awareness and a body-centered approach to playing and singing is essential for all musicians. It keeps us free enough to play well, and gives us the ability to spot the tension that creeps in early, in order to shift it and avoid the more serious problems.
Tendonitis can come from simply not knowing how to use the body effectively as I’ve described, or it can be a small physical problem that is exacerbated with too much playing – a mix of misuse and overuse. If there are no physical or technical issues, and a free, easy approach to the instrument, musicians can usually play for longer than they would imagine. I train my piano students, especially ones wanting to go into the operatic world where they will need to play for 6-9 hours a day, to be able to manage that work load without having unnecessary tensions, aches or pains.
The emotional component
A lot of physical tensions can have can an emotional root and I am still taken aback when I see someone clear up an emotional issue which then has an impact on the physical side of their playing. Most recently, I worked with a pianist who had had tendonitis at music college and had spent years trying to overcome it through various different therapies. Her relationship with the piano had become a battle ground and she would only want to bash it and play angrily, as if she was abusing the instrument. We spent some time finding ways she could feel good at the instrument, see it as her friend, not as the cause of all her problems, along with a much greater self-acceptance. She started to free up at the piano and feel much happier.
The emotional changes could even show physical changes in a matter of minutes. She told me on one occasion that moving through these issues would be hard work – a ‘mountain to climb’ – and noticed her hands, arms and shoulders immediately seized up creating a lot of pain. When I asked her to reassure herself that it was all possible and that she could play without pain, she felt immediate emotional relief. Her hands, arms and shoulders relaxed straight away and she said she could the blood rushing back through her arms.
Where does performance anxiety fit in? Performance anxiety is another major stress, and the fight-flight-freeze response will often show itself in its ‘freeze’ version with musicians. We can tighten up and hold tension in a form of self-protection, a bit like physical armouring. One way of helping to prevent that is to develop greater body awareness along with an understanding of how to best support ourselves physically when playing the instrument. In the moments that the anxiety then kicks in, there is a practised freedom that can be remembered and brought back into sharper focus. And it goes without saying, finding ways of releasing the emotion and the anxiety is key to physically and emotionally free performance.
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