Helping Musicians Feel and Sound Their Best

June 10, 2024

“My hands are falling asleep while I play.” I hear this complaint often. You know the feeling… that tingly, numb, prickly feeling that drives you bonkers. 

In general, the solution is to figure out where the nerve that serves that part of the skin is being compressed, why it’s happening, and make a plan to change it. Most of the time, the compression of the nerve and the resulting symptoms are temporary. We have all woken up with an arm that has fallen asleep because we are lying on it. You take away the compression, and the feeling goes away within minutes. But for those who have this happen regularly or it’s getting in the way of practicing as often or as long as we’d like, it's important to seek treatment for it.

There are three nerves that serve your hands for both sensory and motor information - meaning they can tell you what you’re feeling and tell your hands to move. They all originate from your neck, pass by under your collarbone, and branch off to different parts of your arms and hands. Your hands have regions that are assigned to each nerve: Your pinky, half of your ring finger, and that side of your hand, both front and back, is ulnar nerve territory. The palm side of your thumb, pointer finger, middle finger, half of your ring finger, as well as that part of the palm of your hand, is median nerve territory. The back of your thumb, pointer, middle, and half of your ring finger, and the back of your hand in that region is radial nerve territory.

You don’t need to memorize what the nerves are called. However it is important to know that the location of where you are feeling your symptoms matters. People very often only have that “falling asleep” feeling in one or two of those territories, sometimes all three. But it helps to know which nerves are involved so we can consider the whole pathway from neck to hand and find where the hang-up is.

There are a few common sites where movements or repetitive motion can bug your nerves. Each nerve comes from certain levels in your spine in your neck. For example, if it's your pinky that bothers you, we would look more carefully at the base of your neck, as the ulnar nerve is the area of transition between the base of your neck and your upper back. 

The area under your collarbone is another one. This was true for an upright bassist I worked with a few months ago. She was primarily moving her bow arm with her shoulder blade. So every time her arm moved across her body as she played, her shoulder blade would swing forward and compress the front of her shoulder and ribs where the nerves lived. She was a talented bassist. I was not looking to mess up the strategies that were really working for her at this point in her career, but we had to give her some other options for how to play that wouldn’t compress that spot every single time she used her bow. 

The most famous site is the carpal tunnel at the wrist. I have actually only seen a handful of real carpal tunnel cases in my career. Most people come to me with a diagnosis of carpal tunnel, but the nerve is actually being bothered somewhere else in the pathway. The carpal tunnel is an anatomical structure - a literal tunnel that the nerves and blood vessels to your hand go through in the front of your wrist. If that tunnel gets squished or inflamed, the nerves get sensitized, too. True carpal tunnel syndrome is when someone has symptoms only in their hand on the thumb side of the palm of their hand. Sometimes, it’s only sensation symptoms, and sometimes it’s motor symptoms like weakness or muscle atrophy. Surgery may be necessary to relieve the pressure there, which is why it’s so well known, but a lot of people get better by relieving the pressure in other ways in physical therapy as well. There are other tunnels like this in the elbow and elsewhere; they are just not as well known. 

Overall, the important takeaway is that this is common, most often not dangerous, and if you are having these symptoms - go see someone right away. It’s important to rule out other reasons for the symptoms and of course, there is a chance it can get worse or longer-lasting if you put it off. But the best reason to get thai treated is that these symptoms can often be handled with some straightforward changes, and you don’t have to live with it. So, just go see a physical therapist about it. And if it’s happening while you are practicing or performing, see a PT who knows something about music. It’s helpful if you bring your instrument or a video of you playing to your appointment so the physical therapist can see how you’re moving while you play (just like the bassist I told you about).

If you’d like to hear more about this in audio form, please check out the Play Life Loudly podcast.

If you have any questions or topics you’d like to hear more about, please contact me at abby@forteperformancept.com.

Be well, Abby Halpin

Winter 2024

When something hurts, should I take a break? When is it ok to keep going?”

This is something I am asked about almost every day.

A quick note, I know that musicians often do not get a choice to rest or not, so this answer assumes that the practice schedule is flexible and modifications are possible.

Reasons to take a break from playing:

Playing is painful enough that you dread it

Pain is present while playing and lasts longer than an hour after you finish

A healthcare professional has told you it is unsafe for you to play (second opinions are always an option!)

The pain during or after you play disrupts your sleep

You have a gut feeling that you need a break

Indications that you could keep playing:

You have mild or moderate pain while you play that goes away when you stop

You are able to participate in your self-care and daily activities without limitation

You are working with a healthcare professional who helps you make a plan to keep playing

The pain doesn’t stop you from wanting to play, and you are enjoying your practice time

The question doesn’t have to be “to play or not to play”. The third option is to keep playing but change it up. Play a different genre or style, play in a different position, or play everything softly or lightly. If you can change things enough to get yourself into the “keep playing” category, go for it!

No matter which category you are in, please consider seeing a physical therapist to help with any pain you’re having when you are playing. PTs are really good at breaking big goals down into small, doable plans.

If you have any questions or topics you’d like to hear more about, please contact me at abby<at>forteperformancept<dot>com.

Be well, Abby Halpin, DPT

Spring 2023

A note from your friendly physical therapist…

Teachers, does your body hurt while you teach?

In an Australian study of 505 pianists, 42.4% of the subjects reported pain and injury related to piano playing. Longer practice duration, more years of experience, and higher regularity of playing were all associated with higher reports of problems. And who are our most experienced musicians who spend the most hours at the piano? Our teachers. You!

Don’t worry; it’s not all doom and gloom. Let’s be honest you could be a golf instructor and probably have the same odds of having pain or discomfort. It is part of the human condition, after all. There are strategies specific to music teachers that you employ to limit your discomfort, improve your productivity, and, most importantly, have more fun with your students.

Make your set-up feel easy on you.

Take a look at how you’ve set up your teaching space. Are you comfortable while you’re teaching? Is your chair comfortable? If not, your seating area is the best investment you can make. While sitting in your chair, you should be able to sit all the way back in the chair with your back supported by chair. Your feet should be able to be planted on the floor (or on a step). And when sitting, the chair should be able to do the work of keeping you upright for you. Many believe they should actively hold themselves up with their core all day. But how many hours per week are you teaching? Do you need to torture your core with a marathon of work each day? Let the chair do the work. I will repeat that. Let the chair do the work.

Change it up!

Consider how repetitive some of your movements might be if you are, for example, always sitting to your student's right. You will need to turn your head to the right to read the music; you will always need to reach and turn the page with the same hand and in the same direction. If you need to perch forward on your chair, there will always be a slight rotation to the same side throughout the day. The muscles and joints that have a higher load from being used all the time will eventually protest, and the underused areas are at a higher risk of a surprise injury when they are eventually used during some unexpected movement.

Keeping your body positions variable throughout the day will prevent an over/underload management issue within your body. Try to change up which side of the piano or student you sit on throughout the day. Put a chair on each side of the piano so it’s easy to switch mid-lesson. Even better, get up and move around either within each lesson or between lessons.

Make your day your own.

Individualize your day. Take note of when you start to notice stiffness, pain, fatigue, or sleepiness during your work day. These are ways your body is signaling the need for a change-up. Schedule 5 to 15-minute breaks in your day just before you actually need them (this is the key). If you find that you can make it through 3 student lessons before your body asks for a change-up, make time for getting up and moving after every 3 students.

Get up, walk outside and take a deep breath, go to the bathroom, and refill your water bottle. 

You can even create a 5-minute movement routine to use during these breaks. Make it the same every time so you don’t have to think too hard about it.

Sample routine

1-3 rounds of the following:

Marching in place: Lift one knee and then switch, 10 steps on each side

Kickbacks: Stand on one foot and bend the other knee to kick your foot up toward your buttock. 10x each side

Overhead presses: Raise your arms overhead your head 10x

Pull-aparts: Stand with both hands straight out in front of you. Move your arms out to the side while squeezing your shoulder blades together 10x

Roll-downs: Stand with your knees soft and feet hip-width apart. Exhale and roll slowly down to touch your toes (or at least in that direction). Inhale at the bottom. Exhale and roll back up. 5-10x

Bonus points if you can do it outside and get some natural light to jump-start your brain!

If you are experiencing discomfort during your time teaching, it is valuable to reflect on what is contributing to it and consider changes you can make. You don’t have to hurt! Your students need you at your best, and you deserve to feel good at work.

If you feel you could use some guidance on how to feel better while you teach, please reach out to me anytime at abby<at>forteperformandept<dot>com.

Be well,

Abby Halpin, DPT

Winter 2023

Sometimes you just have to cram in a lot of practice over a short period of time. I get it. It happens. But how to recover from over-practicing, or as I like to say it, under-recovering? And what does rest and recovery look like?

The first thing to do is to figure out how much practicing and resting feel best for you. This varies from person to person and even varies during a musician’s lifetime, so it’ll take a little trial and error. You may have felt great with one passive day and one active day per week for years, but things change, so you have to shift your schedule. Some musicians need a few weeks or months of an “off-season” every year, and others enjoy playing year-round. Each body and brain is different. Each person’s life circumstances are different. The important thing is that you choose something because it feels best for you. And don’t bother comparing your practice schedule to other people. Their circumstances are different than yours, so they have different needs.

Tips for young musicians:

For musicians under eighteen years old, research suggests that organized activity time (including all practice time, rehearsals, lessons, sports, dance, etc.) should be less than or equal to the number of years of their age. So a ten-year-old ideally does not have more than 10 hours of organized activity time per week. More than that significantly increases a child’s chance of injury or burnout. Free play is unlimited!

There are two types of recovery and rest time to include in your practice schedule.

Active recovery is when you are resting from your normal activity while doing something active. You can still play - just make it feel like something else. Most of these options fall under “free play” for those under eighteen.

Play something you have already mastered that feels easy and fun. For me, my go-to is Gymnopedie No. 1 by Erik Satie.

Play something opposite to the skills you’ve been practicing. If you are playing pieces with a lot of big chords, you might change it up and play something full of long runs.

Have a super short practice session. Focus on one short section if it’s a new piece. Or if you are at a point where you can play through it, just play it once or twice to keep it fresh, but don’t dive into the details.

Passive recovery can be further divided into two options:

Option 1: Full-stop - no music or music-related things that day. These days are non-negotiable to stay healthy. Go skiing or hiking with your family, connect with your friends, learn to bake bread, etc.

Option 2: Continued practice, but without the physical playing of your instrument. This strategy is especially helpful when you need a day off but feel like you need to keep learning.

Listen. Listen to other musicians, listen to the pieces you are working on, and listen to recordings of yourself.

Mark up your music. When I was singing in choral groups, there was always time spent penciling in the markings.

Visualize: read through your score and visualize yourself playing. Research shows that visualizing activity causes the appropriate motor units in muscles to contract. This is a great way to work out the timing and coordination without the load of actually playing the instrument. If you have an event coming up, I would also recommend visualizing how the entire event will go. Set things up well in your mind so that you can feel settled in the ways that the day will unfold.

Logistics and organization: Spend some time doing all the nitty gritty things - answer emails, set up your lessons, clean off your music stand and organize your sheet music. Make future you feel uncluttered and settled in your next practice session.

Make sure to have both passive and active recovery days scattered into your practice routine. But if you’ve had a long period of time of over-practicing, or you’re feeling the beginnings of burnout starting, schedule more passive recovery than usual until you feel better. Future-you will thank you for it!

If you’d like to hear more about this, you can listen to the "Rest and Recovery" episode <lk> of my podcast, Play Life Loudly.

If you have any questions or topics you’d like to hear more about, please contact me at abby<at>forteperformancept<dot>com.

Be well, Abby Halpin, DPT

Fall 2022

As a musician, how have you been taught to sit? Many musicians learn to sit on the edge of their chairs, lift their chests and pull their shoulders back. This position is great for communicating that they are ready to start or are alert and engaged. It’s not wrong to sit like that. But the problem is that many students sit that way all the time. Static postures cause the same joints and body parts to bear the same load for long periods, resulting in fatigue and potential injuries, such as back pain or hands that tingle or fall asleep while they practice. It also keeps musicians from moving as they play, which can hinder their connection with the music or audience.

Here are some posture cues to try with your students that allow for dynamic body positions:

• Feel your sit bones on your chair.

• Feel your feet on the floor.

• Lightly float the crown of your head.

They don’t have to use all three cues; there may be one that your student likes the best. If they feel those things, they are likely alert and ready. And they aren’t locked up in the “right” posture all the time, keeping them healthy and connected to their music.

If you have any questions or topics you’d like to hear more about, please contact me at abby<at>forteperformancept<dot>com.

Be well, Abby Halpin, DPT

Abby Halpin, physical therapist and performance coach for musicians of all kinds, and former piano student of a long-time VMTA member, returned to Vermont in 2022. She has shared her work with musicians and teachers in many presentations/demonstrations. Her physical therapy practice, Forte Performance & Physical Therapy, serves musicians in Vermont and nationwide via virtual and at-home sessions. You can find more information about Abby at www<dot>forteperformancept<dot>com and on Instagram at @forteperformancept.