Cello injuries

June 8th 2021

by Marianne Dumas

"Why does my arm hurt playing cello?" 

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All strokes, left hand, and finger movements have a fundamental mechanical structure. Injuries primarily have a mechanical cause.  

During their studies / career, most cellists have to deal with injuries or overuse syndrome. Playing the cello requires a good use of muscles and joints for movement and transmission of weight without too much strength/tension.

When you read news about injured athletes, do you question their talent? No! 


"Roger Federer withdraws from 

French Open due to knee injury concern"  1

"Rafael Nadal continues back injury 

rehab after Miami Open withdrawal" 2

Unfortunately, talking about injuries in classical music is still a taboo. 


This article is dedicated to professional cellists and conservatory students.Too many musician “push through the pain” leading to chronic pain. There are solutions, do not sabotage your career because of this. See yourself as an athlete. Take care of your posture, movement, diet.


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5 most common pains encountered in cellists


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  1. Upper arm pain

  2. Wrist pain

  3. Elbow pain

  4. Neck pain

  5. Middle back pain


4 most common cello injuries

  1. Tendinitis 
  2. Overuse syndrom - Tendonosis 
  3. Bursitis

Most common Tendinitis and tendonosis

Elbow
  • Lateral Epicondylitis Tendinitis & Tendinosis
The tendons on the outside of the elbow that are used to make a fist with your hand. (too much grip!)
  • Medial Epicondylitis Tendinitis & Tendinosis
Injury of the the tendons on the inside of the elbow used to rotate your arm and to flexing your wrist

Shoulder
  • Rotator Cuff Tendonitis & Tendinosis
Tendons surrounding the muscles in your shoulder become inflamed or injured. 

Wrist
De Quervain’s disease (Wrist Tendinitis & Tendinosis)

Tendinitis VS tendinosis 

Tendonitis and tendinosis share many of the same symptoms with the exception that tendinitis is often associated with redness, inflammation and swelling of the injured area, whereas tendinosis is not.*

Principal causes

  • Non optimal coordination/weakness of the shoulder muscles during movement 
  • Non optimal posture (through the thorax, shoulders, and neck).
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Can it become chronic?

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If you do not find the cause of the pain, yes. 

When a tendinitis becomes chronic, there may be restriction of motion of the joint due to scarring or narrowing of the sheath of tissue that surrounds the tendon (see tendonosis below).

There is no "easy fix"but do not think you will lose time, it is the opposite! You will get a stronger technique and better sound after the healing a rehab process.

Why better sound and technique?

Because you will learn:
  • how to use your muscles and articulation in an optimal way
  • how to use the natural elasticity of your muscles
  • how to transmit weight to the string without using too much strength
  • How to use weight, angles, string tension, and speed (for the bow)
It will improve:
  • Left hand strength for demanding repertoire
  • Fingers dexterity
  • bow changes
  • the volume of your sound (rich harmonics)
  • bowing technique and sound at the tip of your bow.

Overuse syndrome or fatigue?


Overuse syndrome happens to professional cellists after an intensive and very demanding practice, recordings, competitions or performance activity. In the best case, it will go away with rest, a lot of water, diet, and good sleep. But be careful with tendinosis.


 There is a common misconception that symptomatic tendon injuries are inflammatory; often are mislabeled as “tendinitis.*

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What is a tendinosis?

Tendinosis is caused by chronic overuse of a tendon. The most common overuse tendinopathies in cellists involve the rotator cuff (shoulder joint), medial and lateral elbow epicondyles.

It can occur in cellists:

  • who practice vigorously without enough rest in between practice sessions
  • whose tendinitis is left untreated
  • with a posture issue
  • with tight calf muscles
Unlike with tendinitis, anti-inflammatory drugs  are not recommended for treatment. They may inhibit the repair of collagen.

Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises. Although topical and systemic nonsteroidal anti-inflammatory drugs are effective for acute pain relief, these cannot be recommended in favor of other analgesics. *

Treatment recommendations include:
  • resting the affected tendon
  • taking a break every 15 minutes
  • applying ice for 15 to 20 minutes, several times a day
  • tape for support of the affected tendon
  • performing light stretching exercises
  • moving the affected area through its natural range of motion to prevent shortening of the related muscles and increase circulation
  • physical therapy, posture work
  • strength training
  • massage
  • nutrition, including vitamin C, manganese, and zinc for the synthesis of collagen production *

Treatment recommendations include:

  • resting the affected tendon
  • taking a break every 15 minutes
  • applying ice for 15 to 20 minutes, several times a day
  • tape for support of the affected tendon
  • performing light stretching exercises
  • moving the affected area through its natural range of motion to prevent shortening of the related muscles and increase circulation
  • physical therapy, posture work
  • strength training
  • massage
  • nutrition, including vitamin C, manganese, and zinc for the synthesis of collagen production *

What is Collagen?

Collagen is a general term for structural proteins in the skin and connective tissue.

Food sources of collagen include the following:

Fish, Chicken, Egg whites, Citrus fruits, Berries, Red and yellow vegetables,  Garlic, White tea, Leafy greens, Cashews, Tomatoes, Bell peppers,  Beans,  Avocados, Soy, Herbs high in collagen (Chinese knotweed, horsetail, gynostemma), Herbs that help to produce collagen (gotukola, bala, ashwagandha). *

"since collagen cannot be absorbed and is broken down into amino acids when consumed, the consumption of collagen does not guarantee that any new collagen will be made."

What about collagen supplements?

"Most collagen supplements undergo hydrolyzation to form hydrolyzed collagen that makes it easier to absorb and turn into tablets, capsules, and powders. Some supplements are infused foods that are drinks and/or edibles injected with collagen. Ingesting more than 20 grams per day may be harmful according to some dieticians."

Can I prevent injuries?

Yes, you surely can! (and should... )
See yourself as an athlete. 

My advice  to help to prevent injuries and keep the tissue as healthy as possible 
  • warming up before starting playing 
  • eat healthy 
  • drinking water regulatly - white tea
  • consider strength training
  • get massages and take breaks regularly
  • light stretching.
Recommended activities 
  • Ergotherapy
  • Sophrology
  • Feldenkrais
  • Alexander Technique
  • Qigong
  • Hatha yoga (done more slowly than Vinyasa yoga, Hatha yoga poses are held for longer, allowing more stretching and muscle strengthing.

Recovering from a tendinitis

Even though it was the tendon was inflamed, the true cause was the musculature. This is why you will have to re-educate.

Good posture puts the neck, head, shoulders, and thorax in the ideal position for muscular efficiency.  It also ensures that the weight is distributed correctly and that the forces placed on each structure are tolerated.

It takes a lot of patience and observation but there is no alternative solution.

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Cello Biomechanics?

I believe that biomechanics is a key area in the development of a cellist because all strokes, left hand, and fingers movements have a fundamental mechanical structure and injuries primarily have a mechanical cause.

OPTIMAL MOVEMENT = OPTIMAL TECHNIQUE


If you need help figuring out the cause of your pain, you can book a session. If I cannot help you, I will not charge you.

Since my schedule is limited, I only work with professional cellists or conservatory students.




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References

  1. https://www.physio-pedia.com/Shoulder_Bursitis#cite_note-19
  2. Conduah, Augustine H., and Champ L. Baker. "Clinical management of scapulothoracic bursitis and the snapping scapula." Sports Health: A Multidisciplinary Approach 2.2 (2010): 147-155
  3. https://www.pthealth.ca/conditions/tendonitis-and-tendinosis/
  4. https://www.medicinenet.com/collagen_diet/article.htm