Piano Guidance
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What is the most painful instrument to play?

The instruments that are the most awkward to hold yield the highest rate of pain: the violin and viola, for instance. "The musicians have to hold their left arms in a godawful position and function in a very intricate way with their hands at the same time.

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When you hear Ravel's "Bolero," do you think of athleticism?

Janet Horvath thinks you should.

"That's a piece almost everyone can recognize," she said. "It's a 14-minute piece; the snare drum plays an unwavering rhythm from start to finish. It's a 24-note pattern over two bars repeated in endless time." Horvath counted the number of snare drum hits: 5,144, quite a strain on the wrists. When she told the snare drummer, he replied that she needed a hobby. So Horvath, now in her 26th season as principal cellist with The Minnesota Orchestra, wrote and self-published "Playing (less) Hurt: An Injury Prevention Guide for Musicians" ($23.95). "Repetition hurts musicians," she said. "Even we don't realize how much repetition we subject our body to and the awkward postures instruments require. "Holding the violin is far from a natural position, and you are holding your arms up for hours on end. People are unaware of how physically grueling it is." Players of most musical instruments face at least some risk of repetitive-stress injury. Professional musicians or serious students, who play hours a day, are most susceptible. The problem is that few people have recognized the problem until recently, Horvath said. "When I had an injury when I was a student [in the late '70s], there were pat answers. A doctor or an incredulous layman would say: `How can it hurt to play?' implying it's all fun and games. `They pay you for that? It's all in your head; you musicians are so sensitive.' Or, `You should try to do something else, change your career.' "For those of us who spent our lifetime practicing, our identity is so wrapped up in the instrument we play it is unimaginable conceiving of doing something else."

Younger players hurt most

Horvath cites a 1988 study by the International Conference of Symphony and Opera Musicians that found that 76 percent of musicians had sustained a career-threatening injury that required a chunk of time off. Musicians ages 35 to 45 were the most likely to report at least one problem (82 percent). The most severe problems hit the youngest musicians.

Why younger?

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"The theory is that people are practicing their hardest trying to get into orchestras, or they are in orchestras for the first time and are overwhelmed with the responsibilities of learning new repertoire," Horvath said, noting she has seen kids as young as 12 with overuse injuries. Several smaller studies have since been done at the college level, with similar findings. "It's pretty common, except people didn't know what it was," said Ross Harbaugh, a cello professor at the University of Miami's Frost School of Music, who has incorporated some of Horvath's warm-up exercises with his students. "With sports medicine becoming more sophisticated and Janet being this crossover person, it's possible for people to not have career-ending injuries like carpal tunnel or tendinitis." Horvath cites several reasons the number of injuries will increase unless musicians learn to protect themselves early. "The 100-yard dash for an athlete seemed impossible to do under 10 seconds. Now it's common," she said. "Same in music. Younger musicians are playing more difficult repertoire. Orchestras are playing more difficult repertoires that seemed unplayable 50 years ago. Instruments evolve and extend the possibilities. Schedules are crazy. Our [orchestra] plays 52 weeks, and we play three to four concerts a week with different music, so we're always having to practice next week's music, and conductors like to program blockbusters to bring the audience in."

Awkward equals painful

The instruments that are the most awkward to hold yield the highest rate of pain: the violin and viola, for instance. "The musicians have to hold their left arms in a godawful position and function in a very intricate way with their hands at the same time. That's asking for trouble," noted oboe player Patricia Nott, dean of musicians at the New World Symphony. Cellists, bassists and harpists suffer lower-back pain. "We sit without back support on the edges of our chairs; that takes its toll," Horvath said. Then there is clarinetist's thumb, for supporting the entire weight of the instrument with one digit. Jaw and neck problems are found among flute players. Keyboard players suffer problems with their wrists.

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"Playing (less) Hurt," now in its fourth printing, features 90 stretches for musicians, do's and don't's lists, a resource list and practicing tips. Sometimes it can be as simple as varying one's repertoire. "If you are stuck on some Brahms piece, you are taxing the same muscles," she said. Maybe you can alternate among several types of pieces to use different muscle groups.

Since musicians' injuries have been recognized, some instruments have been modified.

Take the Pellegrina viola, created in 2001. "It looks like a Salvador Dali viola," Horvath said. It's stretched so that the bottom of the instrument is bigger, the length is reduced so the arm doesn't have to extend so far to hold it, and the upper portion is curved off so it's easier to get around it. "Some musicians have been reluctant to try it," Horvath said. "It looks weird, and they don't want this scarlet letter saying, `Hey, I'm an injured musician.' But most musicians are more willing to experiment with the multitude of things out there. The word has to get out. We're getting out of the closet, but people still don't realize so much help is available."

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