Physiotherapy for Musicians: Perform Better, Prevent Injury

Before he was a physiotherapist, Josh Whelan sang. A master’s degree in voice from the University of Toronto, artist in residence at the Opéra de Montréal, concerts across North America and Europe. He also teaches guitar and piano. An unusual path for someone who now treats wrists and shoulders, and it’s exactly what changes the conversation in the treatment room: he knows the calculation an instrumentalist makes when a pain settles in three weeks before a concert.

Most musicians make that calculation alone. You ease off, change a fingering, put ice on it, keep going. Yet a pain that always returns to the same place after two hours of practice deserves better than an improvised adjustment: it says the load and the way you carry it no longer agree. That’s physiotherapy’s ground.

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The problems musicians commonly run into

The injuries differ with what you hold in your hands, but they all obey two logics: the repetition of the same fine movement, and a position held for a long time without being varied.

For strings, the dominant strain is asymmetry. Violin and viola demand a raised left shoulder, a head tilted and held, a right arm suspended for hours; cello and double bass move that asymmetry around without removing it; the guitar adds a left hand in sustained flexion on the neck. From there come neck and back pain, and shoulder or forearm tendinitis, bursitis included.

For winds and brass, it’s the jaw that works. The embouchure demands fine, constant pressure, held through long phrases, and the breath imposes its own load on the chest and the nape. Jaw tension (TMJ) is frequent there, in singers as in wind players.

At the piano, the strain concentrates in the wrist and forearm. Hours of octaves, fast runs and sustained keyboard work, often with a deviated wrist, form the usual context of tendinitis and of carpal tunnel syndrome, which brings numbness and pain in the hands, in pianists as in string and wind players.

For the voice, the instrument is the whole body. Breath, jaw, neck and shoulder girdle work together, and a tension settled in one reads in the others. That’s why a singer often consults for a neck or a jaw, rarely for their voice.

These pains join what positions held too long in front of a screen produce: the strain isn’t the position, it’s the duration.

That leaves focal dystonia, in a category of its own. This neurological disorder affects the motor control of the fingers or arms and shows itself in the musical movement, often in it alone: the passage worked a thousand times stops obeying, while the hand stays ordinary everywhere else. It’s the most disconcerting condition in the repertoire, and the one that calls first for a proper medical evaluation.

How physiotherapy can help musicians

Physiotherapy offers work that bears as much on the current episode as on what favours it. In a musician, what favours it rarely comes down to the instrument alone: there are the hours, their distribution across the week, the height of the stand, the placement of the score, and the month of the calendar.

The assessment therefore begins with the movement. Biomechanical analysis and postural evaluation serve to see how the movement organizes itself and where it catches. A playing strain is hard to understand at rest: it becomes readable in the movement reproduced.

Then comes what is done with the hands: manual therapy and joint mobilizations, to give back mobility where it’s missing and release what’s tight. Then strengthening and stabilization, calibrated to the real demand of the instrument rather than a generic program, since a musician’s load is measured in hours rather than kilos. Depending on the case, taping, electrotherapy and muscle release are added. And education on postural hygiene and active breaks, the least spectacular part of the work, and the only one that continues without the physiotherapist.

Josh Whelan holds a physiotherapy degree from McGill University and specializes in orthopaedic and sports physiotherapy. Motor control and movement dysfunction are at the centre of his practice, which maps quite directly onto the demands of instrumental playing: working posture, repeated movements, pain that returns to the same places. His stage career and his guitar and piano teaching give him above all a shared vocabulary with the musician: the difficult passages, the practice routines, what a program demands. The other reasons to consult in physiotherapy are the same as for everyone.

The moments that bring people in

Some moments justify an assessment even without a well-settled pain. They are the moments when the load changes faster than the body.

• Coming back after a break. You want your level back quickly, and the volume of practice climbs faster than it had come down.
• Building a new program. Writing that holds the hand in an unusual position, sustained octaves, a heavier role: the demand made of the body changes, sometimes overnight.
• Deadlines that double the work. Conservatory exams, auditions, competitions, going into production: the hours climb while the rest of life doesn’t move.

One last signal, clearer than the others: you’ve started changing your playing to avoid the pain. A fingering changed, a dynamic abandoned, a piece withdrawn from the program. That’s when it’s worth consulting, rather than once the compensation has become a habit.

In summary

It isn’t the instrument that injures. It’s repetition, asymmetry and the calendar, three things that can be worked on, and that are better looked at before the pain has imposed its detours on your playing.

In the Plateau-Mont-Royal, 7 days a week — file opening 60 minutes, follow-ups 30 or 45 minutes. With Josh Whelan, physiotherapist and member of the OPPQ. Book online. Read also: sports acupuncture and dry needling and common conditions treated in physiotherapy. In the clinic: physiotherapy with Josh Whelan and our rates.