Prevention of Injury: The Importance of Posture and Hand Position

Arwen

You may believe that “performance injury” has something to do with athletes, but as a musician, you are at high risk for a variety of muscle and tendon injuries, most of which are due to poor posture and hand position. Often, the foundations of these injuries begin within the first few months of playing, and are easily prevented. Unfortunately, most beginners are quite young, unaware of the dangers of bad posture, and sometimes lacking muscle support that would otherwise add support to their joints. Problems can strike at any age or ability level - even if you have only played for two years and don’t plan a serious career with flute, you may still be at risk for injury. Injuries can be caused by any combination of the following factors: ignoring discomfort or pain, fatigue, over-use of hands or joints (this can be more than with flute-playing - also include extended periods of handwriting, typing, etc), stress, poor posture, cramped hand position, .....you get the idea.

In my case, it was pretty much every factor possible. In January of my grade 12 year, just before finals, my academic and musical schedules were completely insane. I had just been appointed principal flute as well as jazz band tenor sax for that spring’s regional band tour, my marching band was preparing for provincials, I had several prominent solos as jazz band lead alto and concert band solo flute in upcoming festival performances, I was trying to prepare for my grade 9 RCM performance exam, my university auditions were right around the corner, and my teachers were loading on the work in preparation for term finals. (I feel sore just remembering!) I had bad habits, including a cramped right-hand and tense shoulder muscles. Not only was I low on sleep from studying, but my wrists - particularly my right wrist - were heavily overworked from writing pages of notes each block at school (we had 80 minute classes), performing in 7 hours of ensemble time each week, plus my daily one to two hours of personal practice time. I’m surprised my head alone didn’t explode.

At first, I ignored the occasional pain in my wrist, dismissing it as a writing cramp. I thought that it would go away. Worst of all, I thought that I should try practicing daily all at once, to “get it over with.” One morning in early February, I noticed a small yellow bruise on my right wrist. For some reason, I kept in denial. I thought maybe I had hit my wrist accidentally against a door or something. But that night, during jazz practice, I had to stop playing in the middle of my solo. I could hardly play. When I showed my band teacher the bruise, he was horrified and urged me to see a physiotherapist immediately.

Sure enough, it was tendonitis. I had ignored the pain in my wrist for so long, that two of the tendons in my upper arm and wrist had partially ruptured, and the bruise was only a sign of older bleeding. It has become a chronic injury, and though it is not as severe as it might have been, it can still be painful if I do not play with diligence and precaution.

At the start of my recovery, I was unable to play for over a week, and for a month and a half afterward, I had to wear a brace while I played and could only practice for a maximum of half an hour a day. It was devastating. I could only review my music in my head and pencil in phrasing for solos. I tried not to let down my embouchure by practicing with my headjoint and mouthpieces. Due to my lack of practice time, I decided not to take my grade 9 exam. I had to resist the urge to practice for longer periods. The longer sessions that I put in as principal flute at regional practices seemed necessary at the time, but they did not help my wrist to heal. Despite ultrasound therapy, I still have scar tissue in my wrist that inhibits my fingerwork.

Isn’t that a scary story? It still scares me that I ignored the problem for so long. The experience was awful for me as a performer; I don’t want it to happen to you. Bad posture can have long-term effects. The next time your director tells you to sit up in class, uncross your legs, or fix your hand position, you should listen to them. They’re trying to help. For your own practice, I’ve made some simple tips to keep you away from over-use injury:

1. Practice perfect hand position right from the start.

First of all, I don’t want you to misinterpret “perfect” as “tense.” Perfect should always mean that you are free from discomfort. Your fingers, particularly your pinkies, should be curved and at rest on the keys when they are not moving. If possible, try to keep it so that your fingers rest on the key until they are needed to be pushed down, not sticking up in the air until they are used. Keep your right thumb underneath the instrument, closer to you if necessary, not sticking out on the other side. The right hand should form a “C” while you play, or at least a similar open shape. Your left hand will hold the majority of the flute’s weight, while your right hand simply moves the keys. Try practicing some scales without the support of your right thumb. It’s hard, but you need to stop using the right hand as a crutch.

2. Practice playing with a comfortable, upright posture.

Your shoulders should not be hunched while you practice. If you’re sitting down, never, ever sit with your back against the chair. If you feel uncomfortable sitting up, something else is wrong with your posture, such as hunched shoulders or tense hand position. Keep your chin up, and do not lean in towards your music stand. Your flute does not have to be horizontal, but it should not be more than 15 degrees down (never up) from it. No matter what famous flute players perform with really lowered flutes, for a beginner it is a lazy, unnecessary habit. Not only is it terrible posture, but it also has appalling effects on tuning and sound. Your flute is designed to be played near the horizontal, so unless you find it very uncomfortable, play as near to the horizontal as possible. Check out the pictures I made to illustrate this to you!

For wonderful photos of what to do and what not to do when it comes to posture check out this website: http://www.flutelab.com/posture/posture.htm

3. Stretch before you practice.

Make sure that your arms and shoulders are nice and limber before you play. Get into the habit of stretching your arms in front and behind you, and stretching your arms up and behind your shoulders to loosen your arm muscles. Carefully flex your wrists and stretch your neck as well. Make sure to do this gently; you want to warm the muscles up, not overwork or tear them. A great, illustrated guide for these pre-practice stretches is found at http://www.indianahandcenter.com/flex.html. The stretches shown are for office workers who are prone to many of the same repetitive-stress injuries that musicians may suffer from.

4. Don’t over-practice.

Even if you have a million things to get done at once, limit and space out your practice time. For someone in high school, I highly recommend that though you should be practicing at least 45 minutes a day, don’t over-do it. Set your maximum limit at 2 hours a day, or less if you have several ensembles. It comes down to efficiency. Spend 15 to twenty minutes on warm-up (if you need more warm-up time, spend less time on your repertoire), then practice slowly parts you don’t know - get them right the first time, so you can spend as little time as possible getting them perfect. Split up your practice time into chunks - warm up, then practice for 15 minutes at a time, with breaks in between. In this way, less strain is on your body and you can approach the pieces fresh each time.

5. Keep in shape.

Another reason I became injured was the lack of strong muscles in my shoulders and arms. As a cross-country runner and biathlete, I had thought that I worked out enough, with regular running and training schedules. But even in biathlon, I relied mainly upon my legs for speed. Even though I had strong leg muscles, my little arms offered little support to the tendons of my arms, which then bore the weight of the flute alone. To avoid this, get involved in sports such as squash or badminton, or start with some basic arm-strengthening exercises at the gym (again, DON'T over-do it). A fun option is wallclimbing, but be careful not to sprain anything. While you’re healthy, now might be the best time to visit a physiotherapist to assess which of your muscle groups lack necessary strength.

6. Don’t ignore pain or discomfort.

Don’t ignore warning signs like numbness, cramping or pain. In the early stages, it is far easier to heal than when your body reaches its straining point. If the thought, "it'll go away" sounds familiar, you may already be in trouble. Talk to your private lessons teacher, your band teacher, or, at your next appointment, your family doctor, about any discomfort you have felt. Review how busy your schedule is; try to keep it realistic. If an injury does occur, be willing to give up some activities at least until you have healed, if not permanently. Practice with good posture and hand position, and keep reasonable practice times. Be willing to give up activities in order to protect your health.

Best of luck! I hope this article has given you a better idea of how to prevent injury, and helped you to become more aware of any problems in your posture. Please send me an email if you have any further questions!