Dr. Daniel Su, A Tempo Regeneration Center for Musicians

Author: Daniel Chiung Jui Su, MD, RMSK, CIPS

In A Tempo Regeneration Center for Musicians, Dr. Su often encounters musicians complaining that they know their posture is not correct. Still, they cannot do anything about it, feeling like nothing they do is effective.

Some students on their learning journey also find that everything goes wrong after adjusting their posture. They can't play as they like anymore and revert to their original posture.

Sometimes, after practicing a certain piece, they suddenly realize that their posture has changed, whether it's their left or right hand. This change slowly becomes ingrained, eventually leading to injury.

These are common problems I encountered, and through years of practicing, I gradually developed a set of treatments that I named the MOZART therapy.

It was named MOZART therapy because I, Dr. Su, believe it's easy to remember for musicians. This makes it convenient for everyone to review which parts they need to strengthen.

M is for movement correction

M stands for Movement here, which refers to actions or, more broadly, static and dynamic postures. This is the most important aspect in MOZART therapy, as everything fundamentally stems from this M. If the Movement is not optimized, no matter how much effort is put in, the results will be less effective.

However, just emphasizing Movement and attempting to change actions or postures directly can be quite challenging; often, it's not possible to succeed. That's why the following "O Z A R T" steps are needed to assist.

O is for optimization of the instrument

Optimization refers to optimizing the instrument being played and the surrounding setup (such as chairs and auxiliary equipment). Because everyone's body size and fascia structure vary in softness and hardness, optimizing the instrument to adapt to the body rather than the body adapting to the instrument is necessary.

Z is for analyZing the movements

In A Tempo Regenerative center for musicians, we use ultrasound to dynamically analyze the condition of the musculoskeletal system. We also use surface EMG to analyze the playing posture when necessary.

Ultrasound examination is operator-dependent, especially when treating musicians. The quality of the ultrasound scanning and experience will majorly impact the diagnosis. This is also the most challenging aspect of diagnosis among musicians because each instrument, even with the same painful point, requires examining different areas and structures. Therefore, having a check-up in one area doesn't guarantee no issues elsewhere.

A is for knowing your Anatomy better.

Playing music is an art that involves Energy, space, and time, just like the body does. The more we understand how to use our bodies properly and gain correct knowledge, the more we can reduce the chances of making mistakes.

When should stretching be done? Can I work out? Can I get a massage? Why is stretching effective sometimes but not others? All these questions boil down to anatomical and physiological concepts in medicine.

Warming up is necessary before playing, so dynamic activities should take precedence. Stretching should be done after practicing the instrument. But is your stretching correct? Can every muscle be stretched? This requires a more professional assessment.

Can you work out? It depends on which part of your body you want to work out. Not everyone is suitable for working out, and not everyone's current condition is suitable; assessment is needed. Furthermore, working out should mainly focus on the back muscles, and it's best to avoid gripping equipment with your hands. The nuances behind these recommendations vary based on the assessment and the instrument being played.

Massage helps relax tight muscles and restore them to their original length. However, due to poor posture, many muscles are often held in elongated positions while playing an instrument. Massage cannot resolve this kind of soreness and may even worsen it. For musicians, this affects the ease and precision of playing.

Understanding the different anatomical structures associated with each instrument is crucial. These are typically discussed and addressed individually in lectures and our outpatient settings.

In short, the answer to these questions is NOT a simple yes or no. It depends on your condition.

R is for the regeneration of the injured tissues using PRP

During musicians’ lengthy practice sessions, different playing postures for the same instrument can lead to different injury locations. Here, "locations" don't simply refer to broad diagnoses like shoulder pain or tendon inflammation but rather to the precise muscles, nerves, and fascia areas that are affected.

The treatment precision needed for musicians is measured in millimeters.

When we can target areas with a precision of less than 1-5 mm and identify them accurately, that's the level of treatment precision musicians require. Precision is as crucial as it is in our approach to music.

For musicians' regenerative therapy, which uses glucose solution and platelet-rich plasma (PRP) for regeneration, the goal is not only for pain relief by healing the injured tissues but also for rebalancing the body posture in a better position for best performance. This includes playing instruments with more ease and adjusting postures to meet demands better, and as a result, the injection sites are entirely different from those for the general population.

T is for training the right muscles and mindsets.

In a tug-of-war competition, if only the people at the front (labeled as A in the diagram) exert force while those at the back (labeled as C) are not, the front individuals will likely get injured over time. Treating the injured person doesn't help in returning to tug-of-war (or playing the instrument) because the key lies in those at the back who are not exerting force.

Therefore, it's essential to identify and adjust the muscles that are not exerting force or are overexerting in each performer to avoid injuries after picking up the instrument. This adjustment is an ongoing process as long as you're playing, requiring self-assessment, especially when learning new pieces or using challenging techniques.

Training the right mindset is also crucial. The pursuit of musical perfection is a lifelong endeavor.

From childhood to adulthood, from music classes to music school to graduation, experiencing countless performances, competitions, auditions, solo concerts, and more, thoughts of winning and losing inevitably occupy a corner of our minds.

We must constantly remind ourselves of our true intention when facing music. In doing so, we can pursue excellence without excessive attachment to success or failure, ultimately achieving a healthier mindset for practicing and performing.

The pursuit is a growth mindset, focusing on making small improvements every day and progressing slightly in each musical event compared to the previous one, which is something we can control relative to the idea of musical perfection.

Focus on the process, not just the results.

Don't let one concert or performance determine everything; instead, emphasize the development of your musical career. By honestly sharing your efforts and comparing yourself to your past self, you can reduce anxiety and stage fright.

Approaching the pursuit of perfect music with a healthy mindset is crucial because there's no such thing as a perfect performance or perfect music in this world.

Using MOZART therapy, let's move toward a healthier musical career and community.

Poco a poco...

The article was written by Dr. Daniel Su from A Tempo Regeneration Center for Musicians at Chi-Mei Medical Center, Department of Physical Medicine and Rehabilitation, Tainan, Taiwan.

Author: Daniel Chiung Jui Su, MD, RMSK, CIPS

In my clinic, musicians sometimes come in for suggestions on their playing posture. They may want better sound projection, tone quality, or better playability, or simply because feeling discomfort with their original playing posture.

Several factors should be considered when adjusting our playing posture in the classroom or clinic.

1. Instrument itself

How would everyone feel if you walked into a department store today to buy clothes and shoes, but everything was available in only one size? Unfortunately, most professional musicians face this when playing musical instruments.

Most instruments come in 'One size only.’ However, everyone's height, palm size, finger length, finger span, neck length, and shoulder width are different, making it challenging to fit into an instrument.

Let alone instruments like the piano, for which you don’t have any choice of the size of the keyboard….The keyboard of a piano won't shrink because of you! The finger span needed for Rachmaninoff and Chopin is just that large. Shostakovich's intensity must be strong, no matter your physical condition.

Besides the size, the playability of the instrument is crucial!

String players should find a luthier or instrument maker to adjust their instruments. While every instrument may seem the same, too many small details can impact each player's posture, tone quality, and potential muscular-skeletal injuries.

Taiwan's humid climate can cause the fingerboard to sink and the bridge to tilt, affecting string pressing. Conversely, other countries with dry climates may exert extra tension on wood instruments.

When buying a new bow, special attention should also be paid as it can affect the tendons and muscles around the thumbs, pinkies, and wrist joints. This is especially true if the new bow's center of gravity is different from the previous one or if the bow's bite depth or rebound force is stronger, all of which can potentially impact the neck and shoulders.

2. Individual’s physical quality

The arm length, hand size, finger length, and muscular amount of the body are only parts of the parameters when determining the body composition of the musicians. One of the key factors in the present studies, and also the common story in my clinic, is the laxity degree of the ligaments and fascia, which is partly genetic unless it’s an accumulated injury during the practice. Some musicians have stronger ligaments, and some have weaker (more laxity) ones. The ones with more laxity can spread the fingers more open than the others. Still, it also makes it easier to sprain and tear the ligaments, leading to tenderness and impacting the performance outcome.

In addition to the previous two factors, the constant pressure we face in music may also influence and deteriorate our playing posture.

In Taiwan's music competitions for school-age players (and this phenomenon happens in many other countries as well), the repertoire of the free piece is often out of the league for the players. It's not that it can't be done, but our muscles and tendons need time and special practice to adapt to that level of intensity.

I often see various compensatory postures in my clinic due to improper preparation for a sudden increase in intensity or demanding techniques. These postures can become habits and cause injuries that are hard to mend, affecting one's musical career in the long run.

Furthermore, composers usually dedicate their work to the most outstanding contemporary performers, who are among the best in their generation technically, musically, and physically, which puts extra stress if you are a musician in the “norm.”

It’s easier to say than do. In the clinic, musicians often come, even if they are professors in the conservatory or senior players in the professional orchestra, telling me that they know the correct posture and teach their students well, but they don’t know why it’s hard for them to correct their posture. Is it age or muscle memory or what?

We will discuss this question and the solution in the next paragraph.

No pain is pain.

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