After the injury, how should we handle it and return to play following proper treatment?

Author: Dr. Daniel Chiung Jui Su

Case 1: A violinist based overseas had been struggling with a chronic shoulder and neck injury. One week before an international competition, the condition worsened to the point that the violinist could no longer raise the affected arm. After an unsatisfactory competition result, the musician immediately booked a flight back to Taiwan for treatment. 

Case 2: A conservatory viola student had taken a one-year leave of absence from school because of severe shoulder pain. Despite a full year of rest and treatment, the condition had not improved, prompting the student to visit our clinic. 

Case 3: A conservatory cello student had been involved in a serious traffic accident and could no longer play for more than ten minutes at a time. Despite undergoing numerous treatments, the condition failed to improve. The cellist was even told that returning to the instrument might never be possible before eventually coming to our clinic. 

At our specialized clinic for musicians, each patient underwent a comprehensive program that included diagnostic ultrasound, postural and biomechanical correction, and regenerative treatments targeting injured fascia, ligaments, tendons, muscles, and nerves. Surface electromyography training was also incorporated when appropriate. 

After one to three months, their pain and physical limitations had improved substantially. But reducing pain is only the beginning. The next question is: How can musicians safely return to peak performance and continue moving forward? 

This article is written by Dr. Su for every courageous musician who has completed treatment and is preparing to return to the stage—to step once again into the spotlight and feel its warmth. 

Let us now examine each part of it in detail. 

Posture 

After an injury, your posture needs to become even better than it was before in order to reduce the risk of reinjury. In many cases, an injury occurs because the musician’s previous posture and physical capacity can no longer meet the increasing demands of more challenging repertoire. 

The postural adjustments and rehabilitation exercises recommended during your clinic visits should therefore be practiced consistently. If you are uncertain whether your current posture or technique is appropriate, you may email Dr. Su every two months for further review and confirmation. 

Email: dr.daniel@gmail.com 

The Instrument 

How comfortable and responsive an instrument feels will naturally affect how easily it can be played. When returning to the instrument after an injury, it is especially important to remember that, at first, posture matters more than tone quality. Establish the correct posture first, and the sound will follow. 

For left-hand string pressing, begin by using the lightest possible pressure. It is acceptable if the string is not fully stopped at first. The priority is to maintain the correct hand shape, then gradually increase the amount of pressure as control improves. 

Every part of the instrument setup should be adjusted as carefully as possible. This includes the shoulder rest and chin rest for violin and viola, the endpin for cello, the instrument and chair height for double bass, support devices for wind instruments, bench height for pianists, and the placement of drums and percussion equipment. 

For string players, one simple way to help the fingers relearn a relaxed approach to stopping the strings is to use strings with lower tension. For cello, Larsen Magnacore Arioso strings may be a useful option for experiencing how little force is actually needed. Dr. Su has recently tried this set and found that its main characteristics are a softer response and a relatively warm, sweet tone. It may be suitable for smaller halls, chamber music, and even orchestral playing. Comparable lower-tension strings are also available for other string instruments. 

For the bow arm, it may be helpful to borrow several bows from friends or try different options at a violin shop. In general, a bow that is too stiff or too heavy can increase the risk of injury. No matter how beautiful the sound may be, it is not worth using a bow that places excessive strain on the body. 

Practice Strategy 

Do you remember which piece, musical passage, or type of practice first triggered your injury? Identifying these key problem areas is an important first step. You can then work through them one by one—but never force your way through the pain. 

Successful rehabilitation requires thoughtful, efficient practice. Use the least effort necessary, approach difficult passages intelligently, and progress gradually. 

After treatment, practice time should be increased according to a structured plan. 

The schedule shown below is based on a musician who had been unable to play for one year because of a persistent injury before coming to our clinic. After treatment, the musician used this schedule to gradually resume practicing. Each person’s timeline will be different, but the general principle remains the same: 

Increase the frequency of practice sessions before increasing the duration of each session. 

At the beginning, follow a “little and often” approach. It is better to divide practice into short sessions in the morning, afternoon, and evening than to complete one long practice session all at once. 

It is important to understand that Day 1 will be different for every musician. Some may begin as early as two days after treatment, while others may need to wait up to one month. The starting point also varies. For example, if a musician can already play comfortably for one hour, the progression may begin from that one-hour baseline. 

During follow-up visits, Dr. Su will provide individualized guidance based on each musician’s condition, recovery, and performance demands. 

Warm Up Before Playing—Do Not Stretch 

Before practicing, what the body needs is a proper warm-up, not static stretching. 

Stretching immediately before playing may temporarily reduce muscular responsiveness, speed, and performance capacity, thereby increasing the risk of injury. A dynamic warm-up is therefore more appropriate before practice or performance. 

Stretching is better performed after playing, when it can help relax muscles that have remained contracted or active during practice. 

Lifestyle, Nutrition, and Emotional Well-Being 

Developing healthy rest and sleep habits is one of the most important foundations of physical recovery. 

After regenerative treatment, injured tissues require sufficient nutrients to repair and rebuild. Adequate protein intake is therefore important, along with vitamins B and C, particularly during the first three months after the injection. 

Emotional well-being is also an essential part of recovery. Reading about mindfulness or meditation may help support both physical and psychological health. It may also be helpful to reflect on what this injury has taught you and how the experience can contribute to your growth as both a musician and a person. 

Fascia, Ligaments, Muscles, and Nerves 

After treatment, the fascia, ligaments, and muscles generally require approximately six weeks to reach a more stable stage of recovery. During this period, musicians should still avoid overly intensive practice, heavy lifting, and other activities that place excessive stress on the treated tissues. 

Post PRP care for musicians

Exercises to restore muscular balance can be gradually introduced after approximately six weeks. However, this does not mean conventional heavy resistance training. Instead, musicians should perform the specific exercises taught by Dr. Su during the clinic visit, tailored to the physical and biomechanical demands of their individual instrument. 

For patients who already have numbness or other symptoms related to nerve injury, recovery may take longer. In more severe cases, nerve healing often occurs gradually over several months. 

In the music of life, uncertainty is the only constant.