What is Musculoskeletal injuries?

Since violin playing is about physical as much as mental, it is important for the body to be healthily functioning and relaxed. While performing some parts of the body is visibly used more than the other parts. These parts – hands, shoulders, neck, and back are also more inclined to get injured before and/or during the performance.

Injuries caused by musical training are widely discussed throughout the musical literature. One of the most significant research was commissioned by the International Conference of Symphony and Opera Musicians (ICSOM), 1985, and collected by Fishbein et al. (1988), which states 76% of professional orchestra musicians had had at least one intensive performance-impacting medical problem.

Since every single person’s anatomy is slightly different, his or her performing style alters respectively. Hence, a musician should be aware of his/her anatomy and adapt playing techniques accordingly to avoid injuries. The injuries caused by maladapted playing techniques also vary according to one’s variant anatomy. Injuries also vary according to the instrument one is playing. As Fry (1986a) states fingers and wrists are the most used organs while playing regarding elbow and shoulder. According to Fry et al. (1987), string instrument players differ in this sense from other instrumentalists since they use shoulder more while performing .

It is essential to discipline all the muscles in the body and strengthen the core to prevent musculoskeletal injuries. A core can be both centers of the body weight and the movement. Moving from the core could help to include all the body parts to the movement. This helps whole skeletal system to support the muscles that are linked to each other directly or indirectly. For example, a violinist uses his/her hands and arms to perform. Arms are considered as a big and heavy type of limbs, and they are attached to scapulothoracic or shoulder girdle. If the muscles supporting scapulothoracic girdle are not, strong enough injuries are more likely to occur.

Mainly injuries happen in upper back and shoulders are caused by asymmetric posturing. Asymmetric posturing while continuous practicing and performing strengthen used part of the body, leaving the unused part quite weak. The unbalanced strength of muscles and dissymmetrical posture of the spine prevents natural body movements leading to musculoskeletal damages.

Since violinists suffer from a different variety of injuries that are related to playing, it is essential them to have knowledge about the common injury types to observe their symptoms before it turns out to be chronic. Most common locomotor system and peripheric nervous system problems violinists experience are Musculoskeletal Overuse Syndrome, Tendinitis, Lateral Epicondylitis, Carpal tunnel syndrome, Kubital tunnel syndrome and Focal Dystonia. There are also Playing related pains and Playing related dermatological problems that violinists are suffer from.

Musculoskeletal overuse syndrome

Musculoskeletal overuse is a condition in which the body can not adapt to overwork and some complaints arise accordingly. This condition occurs with pain, swelling in the affected area, rash and temperature increase. String instrument players mostly experience musculotendinous, while pianists can have motor control disorders. The condition may heal if the players give some break with instrument practice and have some rest.

Musculoskeletal overuse syndrome causes sore muscles and loss of control that results from overuse of fundamental limbs. Hoppmann underlines the fact that this syndrome is frequently seen in instrumentalists. He also points out the names musculotendinous overuse, nerve entrapment/thoracic outlet syndrome, or motor dysfunction, which are some of the diagnoses that are classified under musculoskeletal overuse syndrome. Within these symptoms, it is also important to note that hypermobility and degenerative arthritis are very likely to be developed. According to the prevalence rates, while string players suffer from musculotendinous overuse, keyboard players are affected by motor dysfunction.


Tendinitis is a condition resulting from the inflammation of tendons. Tendons are tissues that connect muscles to bones. The movement of specifically tight tendons results in pain and stiffness occurs on the tendon. Tendinitis is a common disease amongviolinists, especially on their thumbs and elbows. In such a case, it may be necessary to reduce the amount of instrument practice. Since tendons connect bones to joints, in the case of repetition, injury and infection are likely to occur. Considering practicing methods of musicians include a lot of repetition, it is no surprise to see tendinitis frequently diagnosed in this profession, especially in thumbs and elbows.

Lateral epicondylitis

Lateral epicondylitis, also known as tennis elbow, is the outer part of the elbow. Tendons extending towards the wrist and the hand are attached here. Not only impacts on the elbow, but also the movements of fingers and wrist may result in injury in this area and the rupture of the tendon fibres attached here. It is a disease characterized by pain and tenderness on the bone on the lateral elbow. When skin-deep extensors are continuously used in the forearm or severe injury occurs in the elbow, lateral epicondylitis is likely to develop afterward.

Not only hand and wrist but also elbow is extended and bended when the hand is bended and extended at the wrist or with immediate moves and hits required by the sports of tennis and golf. Tendons can be ruptured or injured during these movements, and in some cases even small pieces of bones can be ruptured.

This disease occurs especially on the left elbow among violinists. The pain occurring on the upper arm, lateral or lower elbow spreads from the elbow to the wrist. Caldron et al. (1985) state that the repetitive bending and twisting done by instrumentalists makes them candidates for lateral epicondylitis. According to Itoi et al. string players are more likely to experience this condition in the left elbow because it is used for fingering rather than bowing with the right hand.

Carpal tunnel syndrome

Carpal tunnel is a syndrome that can be caused by constantly making the same move. It results from the compression of the median nerve, one of the three major nerves in the hand, while travelling through the tunnel-shaped structure located between the bones of the wrist. This syndrome, which is common especially among pianists, can occur for two reasons. There may be inflammation in the tendons passing through the same tunnel with the nerve, or there may be disorder in the arrangement of the bones forming the tunnel or the tunnel may be too narrow. Pain that can wake up at night is one of the symptoms of the syndrome. While holding the objects in hand, objects in the hand can be dropped with momentary weakness.

It is the most frequent diagnosed nerve entrapment syndrome and may cause wrist pain, numbness in the hands and fingers, a burning sensation, and loss of power and lack of coordination in the thumb, index finger, middle finger, and ring finger. People who are diagnosed with carpal tunnel syndrome might have trouble performing actions involving the tip of the thumb. It is important to take a break when working to avoid carpal tunnel. Especially hard work should be done with necessary breaks.

Cubital tunnel syndrome

It is a syndrome resulting from the compression of the ulnar nerve, one of the three nerves of the hand, in the elbow and it occur with numbness in the little and ring fingers and loss of strength in hands. The ulnar nerve passes through the groove between the two bony protrusions in the elbow, which is called the cubital tunnel. This syndrome can occur due to fractures, swellings, cysts, masses or long-term bending of the area as in musicians.

The first symptoms are numbness, tingling and pain in little and ring fingers. This pain and numbness is spread to the inner elbow from the little finger. Atrophy may develop in the elbow muscles as the syndrome progresses. When two hands are compared, the affected side will be noticeably thinner. If it develops further, the little and ring finger can bend. It is recommended that the elbow not be bent too much and the elbow can be rested with night splint. Cubital tunnel syndrome is a subtype of nerve entrapment syndrome, which occurs when the ulnar nerve gets compressed in the elbows. Patients who experience this condition might lose strength and feel numbness in their ring and small fingers.

Focal dystonia

Focal dystonia, also known as musician dystonia or musician cramp, is the involuntary, uncontrolled contraction in a part of the body. Involuntary muscle contractions resulting from overuse disturb the harmony between the muscles, which makes control of the movements difficult. Contractions in the muscles cause bodily posture disorders and repetitive bodily movements, whichmake the movements difficult. This is anervous system syndrome.

Some after the musicians start to move, involuntary contractions occur in the muscles that operate the wrists and fingers. Opposing contractions occur in muscle groups that need to be relaxed during movement. In such a case, the musician becomes unable to play the instrument. In such a case, rest is recommended first and the way of practicing of the instrument must be improved. While piano players experience these contractions mostly in the fourth and fifth fingers of the right hand, guitar players experience them in the third finger of their right hand. Flute players, on the other hand, experience them in the left hand, and violinists have contractions in both hands.

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