Subject: Re: ergo musicians 
Date: Tue, 13 Nov 2001 17:16:46 -0500 

>Does anyone have any references for musicians and ergonomics? I 
>specifically have someone who plays the violin (strings) and would 
>like to use and pass on any information I can to the user. 

Eric,
You've asked a question near and dear to my heart. I have treated musicians 
clinically (as an occupational therapist) and have two daughters who are 
very promising violinists. As a proud father of these two wonderful 
daughters, I of course want to make sure that an injury does not get in the 
way of their musical development. Clinically, I have seen firsthand some of 
the common biomechanical problems associated with violinist injuries. Some 
common faults among violinists:

Locking the knees while standing - this creates trunk and pelvis rigidity 
which in turn restricts freedom of movement in the upper limbs and upper 
trunk.

"Wrapping" self around the violin - the violinist literally looks like their 
upper body is wrapped around the instrument with protracted (forward) 
shoulders, forward head posture and increased kyphotic curve of the thoracic 
spine. This high-tension posture also limits freedom of upper extremity 
movement, actually affecting tonal quality of playing and ability to change 
positions rapidly and smoothly. Over time, the pectoralis (chest) muscles 
shorten, tighten and strengthen and the muscles controlling the scapulas 
weaken and lengthen - this leads to a variety of shoulder dysfunctions.

Static forward head posture with lateral flexion & rotation to the left 
while holding violin - this can be significantly improved with the proper 
shoulder and chin rests.

Left wrist positioned in extremes of flexion or extension - this causes 
increased pressure in the carpal tunnel space and requires a greater 
percentage of maximum voluntary contraction of the finger flexors due to the 
biomechanical and physiological disadvantage of this posture - resulting in 
more rapid onset of fatigue. (My oldest daughter was studying with a 
well-known violinist that insisted upon a fully extended wrist posture - 
wrapping the thumb to the top of the fingerboard. She developed wrist and 
concomitant shoulder pain. After discussing this with the violinist and 
illustrating the biomechanical problems associated with this, he refused to 
change his demands. We dumped him. Pain resolved.)

A protracted (forward) and hyperadducted (arm tucked in tight to body, even 
to the point of the elbow being near the midline of the body) left shoulder 
posture - causes increased forearm supination (palm up motion), external 
shoulder rotation, and awkward wrist deviation.

Too intense finger pressure on strings - more rapid fatigue and decreased 
dexterity.

Too rigid right shoulder posture (bowing arm) - results in increased elbow 
motion and deviated and flexed wrist postures.

Sitting slouched - limits upper trunk movement and increases internal spinal 
disk pressures.

Sitting with rotated trunk to see music stand.

It is key that the violinist has fluid movement of the pelvis, spine, and 
the entire upper limbs. This dynamic movement improves circulation to the 
muscles, increasing oxygen and sugar flow (the muscles' "fuel") and 
decreasing the buildup of toxic wastes such as lactic acid (the muscles' 
"exhaust").

One very anecdotal observation: there are a variety of schools of thought 
regarding violin playing technique. I have noticed that people trained in 
the Russian-influenced techniques are more rigid in their style and appear 
to assume more awkward, non-neutral postures, hence, are more likely to be 
at risk for musculoskeletal injury.

Professional musicians and motivated students tend to be very "driven" in 
their practice habits, practicing long and hard, losing focus and awareness 
of bodily discomfort. The most important instruction I give my musician 
patients and my daughters is the importance of warm-up stretching and 
periodic breaks to break up the unavoidable static postures associated with 
less-than-optimal instrument design.

Here's a link of interest when considering the design of a string 
instrument: 
http://www.msen.com/~violins/news/strad/nov00/Erdesz_bio.htm - scroll down 
and look for the interesting cut-away viola design - designed to reduce 
extreme wrist flexion while reaching for the upper positions.

References of interest: 
Orthopaedic Physical Therapy Clinics of North America, Volume 6, Number 2, 
June 1997 
The entire issue is devoted to P.T. for the Performing Artist. Of 
particular interest to your violinist friend might be "The Biomechanical 
Examination of a Musician with a Performance-Related Injury" by Nicholas 
Quarrier, p. 145-158; and "Applied Ergonomics: Adaptive Equipment and 
Instrument Modification for Musicians" by Richard Norris and Jan Dommerholt, 
p. 159-184

I would also highly recommend the book "The Athletic Musician: A Guide to 
Playing Without Pain" by Barbara Paull and Christine Harrison: 
(http://www.booksamillion.com/ncom/books?id=2056606589055&pid=0810833565) 
Ms. Paull is an orthopedic physiotherapist and Ms. Harrison is a 
professional violinist.