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Instrumental musicians are prone to numerous playing-related musculoskeletal disorders, including inflammation of tendons and other soft tissues (tendonitis, tenosynovitis, epicondylitis, bursitis), nerve compressions (carpal tunnel syndrome, cubital tunnel syndrome) and a less understood condition commonly referred to as overuse syndrome, which leads to pain and loss of function in the affected region but with no obvious diagnosis.

Although the exact mechanism of these musculoskeletal disorders in relation to playing remains unclear, they are widely considered to be associated with the concept of overuse, where normal but excessive, repetitive or unaccustomed use leads to soft tissue damage, either acutely or over time.

Overuse with poor posture is another cause of injuries in musicians and refers to soft-tissue damage from repetitive movements over a period of time, or overloading unprepared muscles and tendons.

Musicians who do not give themselves a long enough lead time for a new repertoire with a different technical demand, or who do not give themselves enough time for rest and recovery, are more vulnerable to overuse injuries. From a teaching perspective, introduce new and possibly demanding work to your students with enough time for them to build up to a performance in order to avoid injury.

Due to the potentially devastating impact of playing-related musculoskeletal disorders on the ability to perform, prevention is of paramount importance. Given the many hours spent practising and rehearsing each day – especially when preparing for public performances, auditions and competitions – the potential for overuse should be mitigated by adopting preventative behaviours, including good practice hygiene, a regular daily routine, appropriate pacing across academic and professional schedules and allowing adequate time for rest and recovery.

Research with over 2,500 orchestral musicians (Steinmetz 2015) showed that more than one in two (55%) were suffering at the time of the research from physical problems that affected their playing. The prevalence increased significantly with advancing age, and string players and harpists had an above-average frequency of experiencing physical problems.

Injuries develop over time and often start with small aches and pains that are ignored. Ask your students if they get any pain which might be caused by playing. Pain when playing may be a warning sign of an underlying problem and should never be ignored. Students should therefore be advised to seek help from a clinical expert as early as possible to avoid their symptoms worsening or becoming chronic and thus more difficult to treat.

For further details on reducing the risk of overuse, please refer to the sections in this guide on Routine and Rest and Recovery.