Health Matters: Physical Therapy Hits the Right Notes with Musicians


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By Hemangi Shastri, DPT, CHT, CEAS II

Musicians are athletes, and just like baseball pitchers or tennis players, musicians can experience repetitive motion injuries that can make playing painful.

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Several studies show that a high percentage of musicians will experience a repetitive motion injury.

In some cases, taking a rest from playing will solve the problem, but in other instances intervention may be needed.

The Outpatient Rehabilitation Program for Musicians at Penn Medicine Princeton Medical Center (PMC) provides effective, evidence-based treatment for various musculoskeletal disorders experienced by people who play instruments.

An Increased Risk

Regularly playing a musical instrument — whether it is a string, wind, or percussion instrument or a keyboard — can result in a range of musculoskeletal disorders in the hands, wrists, and arms.

Long hours of practice, awkward postures, and repetitive motion all have an impact over time, increasing the risk for injuries.

Carpal tunnel syndrome, tendinitis and bursitis, as well as back and neck pain, are common to musicians.

Carpal Tunnel Syndrome

As the American Academy of Orthopaedic Surgeons (AAOS) explains, carpal tunnel syndrome occurs when the median nerve, one of the major nerves to the hand, is squeezed or compressed as it travels through the wrist.

According to the AAOS, most cases of carpal tunnel syndrome are caused by a combination of factors. For musicians, repetitive hand use and activities that involve extreme flexion or extension of the hand and wrist over a prolonged period are two of the biggest risk factors.

Both can increase pressure on the median nerve, leading to symptoms that include:

• Numbness or tingling in the fingers, especially the thumb and the index and middle fingers.
• Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers.
• Pain or tingling that may radiate up the forearm toward the shoulder.
• Hand weakness.
• Decreased fine motor coordination.
• Clumsiness.

Carpal tunnel syndrome typically gets worse over time, and according to the AAOS, can lead to permanent dysfunction of the hand if left untreated for too long.

Tendinitis and Bursitis

Tendinitis, as noted by AAOS, is an inflammation or irritation of a tendon — the thick fibrous cords that attach muscle to bone. In musicians, tendinitis is most common in the shoulders, elbows, and wrists and is a result of a series of small stresses that repeatedly aggravate the tendon.

According to the AAOS, symptoms of tendinitis include:

  • Pain, often described as a dull ache, that typically gets worse with movement.
  • Tenderness.
  • Mild swelling.

Bursitis, according to AAOS, is inflammation of a bursa, one of the small, fluid-filled sacs located throughout the body that act as cushions between bones and soft tissues and help to reduce friction. In musicians, bursitis usually occurs in the elbow and shoulder, and like with tendinitis is a result of repeated small stresses and overuse.

Symptoms of bursitis include pain and swelling. In many people, bursitis and tendinitis will often occur together, according to the AAOS.

Don’t Play Through Pain

If you suffer from hand, elbow, or arm pain, it is important to see your doctor for a correct diagnosis. In many cases, they will recommend physical therapy as part of your overall treatment plan.

The Outpatient Rehabilitation Program for Musicians at PMC provides patients with a personalized evaluation that includes:

  • Postural screening.
  • An overall strength and flexibility assessment.
  • An instrument-specific ergonomic evaluation.
  • Expert analysis on playing-related muscle pain and dysfunction.

Treatment includes:

• Strength and flexibility exercises to alleviate the physical stress caused by playing an instrument.
• Hands-on therapeutic techniques for reducing tightness and pain.
• Education on injury prevention.
• Assistance in improving overall strength, agility, and endurance necessary for practice and performance.

After a few sessions, which are usually covered by insurance, musicians typically have the tools in place to heal and prevent future injury.

Tips for Preventing Injury

The American Orthopaedic Society for Sports Medicine offers these tips to help musicians prevent repetitive motion injuries:

• Perform warmup exercises before playing and cooldown exercises afterward, especially for the shoulders, elbows, hands, and upper back/neck.
• Take short breaks during long practice sessions.
• Adopt a practice or rehearsal schedule that allows more intense playing to be interspersed with practice that is less intense and varies the muscles being used.
• Discuss appropriate, efficient music technique with a qualified music teacher, including how it relates to the repertoire.
• Apply ice for 15 minutes after playing for minor aches and discomfort.

If you are a musician who is persistently playing through pain, talk to your doctor about how physical therapy can help alleviate your symptoms and keep you hitting all the right notes.

For more information about the Outpatient Rehabilitation Program for Musicians at PMC, call 609-655-4586 or visit

Hemangi Shastri, DPT, CHT, CEAS II is a trained musician and certified hand therapist with Penn Medicine Princeton Medical Center.


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