Overuse found me in early 2013, but it had probably been brewing long before the symptoms began. That year, my studio ballooned from ten to 33 students. Twenty of my students were young beginners working their way through the repetitious Twinkle Variations. As I taught for up to six hours in a row, a nagging pain developed in my right wrist and thumb. Since then, I have had various overuse problems in my right arm and shoulder, usually as stiffness, slight to moderate pain, and occasional faint tingling. "Injury" is a slightly odd word to describe my condition, since it isn't always painful and isn't linked to one acute event. It crept up on me. And, I kept up with a mostly normal workload and life during the injury. I played fun concerts, conquered difficult rock climbs, put in long hours on the computer, and taught many lessons. But, it wasn't getting better on its own. Three years after it began, I have committed myself to healing completely, and it is going to be a process.
Overuse is an insidious thing, especially when it is connected to work. It is difficult to stop working, and too easy just to do a little more than you should. Unfortunately, injury is also a nearly taboo topic in music. Many (or most) musicians play with pain some or all of the time, but rarely speak of it. Musicians risk losing their already tenuous jobs if they cannot play. They often don’t have good health insurance, and physical therapy is not cheap. So, many people simply keep playing and assume that soreness or discomfort is part of the job. At the same time, however, violin teachers speak constantly about avoiding tension and have heated arguments over what techniques promote or discourage tension in their students' playing. The implicit message if you get injured is that you did something wrong: you played with tension or bad form. You didn’t take care of it soon enough. You are a failure.
However, among my athlete friends, injury is a common and somewhat accepted occurrence. Sure, nobody wants to be hurt, but anyone running ultra marathons, racing bikes professionally, or trying to become a 5.12 climber is pushing the limit of his or her body. They will probably make a visit to the physical therapist at one time or another, and possibly go through a season of resting and recovering from an injury. Taking care of the body and doing strengthening exercises is an important part of sport. Knee, shoulder, tendon, and surgery stories are common topics of conversation, and nobody is frowned upon for injury. Nearly every one of my athlete friends has worked through an injury and come out stronger for it. Further, many of my friends who work for high-powered companies have entire departments dedicated to setting them up ergonomically so they don't get repetitive strain injuries at the computer. Musicians have little to none of this.
Even as I type this, I feel slightly hesitant about posting this due to the stigma of overuse injury among musicians. However, I think music needs a cultural change, so I am going to be part of that change by sharing my story. Musicians are athletes. Overuse is not a personal failure, it is a mechanical breakdown resulting from fatigue and moving repetitiously in less than ideal ways. The injury needs to be treated and the patterns need to be re-trained; better yet, the patterns need to be prevented and cared for in advance. When you do a repetitive task, even if you usually have good posture, muscles and tendons can get tired and strained. If you push through fatigue, your alignment might slouch and other parts of the body will try to help out to protect the strained muscles. Slowly, unwittingly, your body begins to compensate. These compensations are subtle, but they often become a permanent, unconscious habit over time. For me, my right arm dropped forward and down about a centimeter when I was fatigued. Then, I played the violin for hours in this position, put in long hours on the computer in a less-than-optimal setup, and spent many hours riding road bikes in a position that exacerbated the imbalance and nerve compression. (Great article about road biking and TOS here.) Pain may not show up for years after poor movement habits are formed. Even though my right arm had always felt fine, my sudden increase in work in 2013 was likely the straw that broke the camel’s back.
Like most musicians, I kept up my life and career during the injury. To my credit, I was very aware of the dangers of overuse and tried to figure things out early on. I went to physical therapy and massage right away, but didn’t make a full recovery and then the insurance company denied a renewal to my prescription because they don't cover chronic injury. I studied body mapping, Alexander Technique, and tried to use good alignment when I played. I learned a lot about the body. But, I was also busy building my career. Gradually, my Twinklers turned into Book One students, then Book Two students...some of them have finally reached Book Four! The less motivated students moved on and the good students told their friends about me. My studio got better and better. This spring, I tried physical therapy again and made some progress, but didn't really understand what was going on and why. Then, Jon switched to a corporate job and they gave us lousy insurance with a very high deductible. I also had a whirlwind spring and summer this year: concerts, workshops, and guest teaching opportunities. In August, I took a whole month off of playing and teaching, hoping that my arm would heal and be back to normal when school started. Instead, I spent the whole week of my Oregon coast bike trip with a numb right arm: my touring bike puts me in a posture that compresses the irritated nerves in my neck, leading to numbness in the arm. I came home and dove into to a big, stressful music festival scheduling project that left my neck and shoulder muscles knotted. Rest hadn't worked. My arm was in no better shape than before. The musician's life is not conducive to recovering from overuse!
Well, it was time for a big life change. I quit the two music festival scheduling projects I'd been doing. Reluctantly, I emailed my orchestra director to let him know I was taking some time off. I signed up for an introductory yoga class and resumed studying Alexander Technique. Jon went back to work at the UW and we switched health insurance AGAIN, our fifth new policy in three years. Thankfully it's a generous policy. I found Kinetic Sports Rehab, where I have a fantastic team caring for me and coaching me through my recovery. They spent a long time watching me move and testing me before explaining exactly what movement patterns led to an injury called thoracic outlet syndrome, a nerve compression in my right neck/shoulder. My case isn’t too severe, thankfully. Any tingling I have is very faint and intermittent, aggravated by specific movements and positions. But, treating it is a long process, since the surrounding muscles and tissues are constricted due to years of overuse. Right now, I can’t bike, rock climb, or play the violin much, and I am going to Kinetic three times a week. Each visit, they work on my arm to free up the tissue and mobility. I get kinesio tape put on my shoulder or neck to cue up my muscles and remind my body of good alignment. They coach me through very specific exercises that help me re-train and strengthen my body. I can feel it starting to work. Life goes on somewhat normally. I can teach just fine, I'm running a lot lately, and enjoying yoga.
Fortunately, the body knows a lot. When you return to better movement patterns, it feels good. You get stronger in the right places and re-train your muscles, which then helps you move even better. It becomes a virtuous cycle. I can feel myself entering into this cycle. I will make a full recovery, study the body and its mechanics, and become an even better teacher and violinist than I was before. Every time I finish working for the day, I'll take ten minutes to decompress (literally) and roll out the muscles that just worked so hard, just like an athlete cooling down. Speaking of which, I have been on the computer long enough for one day and I am starting to feel it a bit. I think I’ll go do my PT exercises right now.