Perhaps more than ever, music educators are taking measures to help ensure the health of their students. However, more care should be given to help our students avoid common musculoskeletal and nerve entrapment injuries to their hands and wrists. Fortunately, simple steps can be taken to prevent painful injuries to our reed players without using excessive rehearsal time.
Because every human body is unique, no two players will share an identical approach to the physical aspects of playing a musical instrument. That being said, there are principals that can and should be applied to everybody (or, every body). Efficiency of motion in the fingers, elimination of excess tension in the hands and wrists, and avoidance of excessive bending (flexion or extension) of the wrist joints are key to musculoskeletal health for reed players.
There are slight differences between the hand positions/shapes required for the various members of the saxophone and clarinet family, but our ideal starting point is the same: the relaxed “C” shape that most of us form when we let our arms hang completely relaxed at our sides. When we let our arms dangle, we see that our hands and wrists are aligned in a neutral position (no wrist flexion or extension in any direction). The closer we keep our hand shape and hand/wrist alignment to this configuration when we play, the less strain (and injury risk) we will experience.
One way that I demonstrate this alignment is having a student hold a 16 or 20 ounce drink bottle in either hand (in a vertical “playing” position) and observe the position of the hand/thumb/wrist. Most students will hold the bottle with a “healthy”, relaxed thumb position and without extraneous tension. This relaxed arch position of the hand should be the basis for hand position as much as possible (noting that for most students, the “C” shape will be more closed at the finger tips when covering tones holes or closing keys). Again, we should strive for a “line” or very gentle “curves” (minimal flexion) through the wrist, rather than a pronounced bend in any direction at these joints.
Additionally, keeping the instrument in good repair is important to hand/wrist health. Woodwind students with leaky instruments unconsciously learn to squeeze keys closed, if necessary, to force their instruments to seal properly. The extra exertion required causes fatigue in the hands and wrists, particularly if the student practices and rehearses regularly.
Use of a Neckstrap
Single reed musicians often experience musculoskeletal injuries due to awkward position of the right thumb. Likewise, excessive weight bearing by the thumb can produce the same ill effect. Fortunately, simple preventative measures can be taken to prevent these injuries.
For saxophonists, proper adjustment of the neck strap (so that the strap sits low onto the top of the shoulders, and the mouthpiece tips into the mouth and rests on the cushion of the lower lip) and adjustment of the right-hand thumb hook will be of great help. It is important to remind saxophonists that the thumb hook is NOT intended to bear the weight of the instrument; rather, is there to keep the right hand in the proper playing position.
The topic of clarinet hand and wrist position is somewhat complicated because many clarinets have thumb rests that place the right thumb in a low, exaggerated abducted position. This has the potential to cause discomfort, and eventual injury, by placing significant load and strain on the abductor pollicis longis (APL) as it distributes the clarinet’s weight to the wrist. Fortunately, many recent trends in design and application can help prevent this issue. Adjustable thumb rests, which allow the position of the rest to be raised or lowered vertically to accommodate the players physiology, are readily available as “original equipment” options or as aftermarket additions. An inexpensive way to potentially improve the health of student clarinetists is the use of a clarinet neck strap, which can easily be attached to most thumb rests. Many top professional clarinetists, as well as students, are opting to use neck straps to significantly reduce the weight that is bore by the right thumb. In the past there has been some controversy as to whether the clarinet can be taught or played correctly using a neck strap, but the benefits can be significant as long as clarinet students are still being taught proper instrument angle and hand position.
Of course, if students are already experiencing pain or any loss of sensation or motion in their upper extremities, they should contact their doctor immediately. However, a few moments of time at the beginning of a few rehearsals, followed by regular reminders, can help steer students toward a habit of maintaining healthy hands, wrists, backs, and shoulders.
I highly recommend that all instrumental music educators take 7 minutes to view the video “Finger & Upper Extremity Stretches for Musicians” on the Physical Therapy 101 YouTube channel. Here, Dr. Anderson Dart and Dr. Nick Gallo concisely introduce several simple warmups and stretches that can quickly be taught to even your youngest students. Select two or three that you would like to introduce to your class, then reinforce the habit by reminding and guiding them through the warmups or stretches several times per month. Rehearsal time is precious, but even a few minutes per semester may help keep students from experiencing discomfort, needing wrist braces, or from “time off” of playing. I have had many long conversations with woodwind musicians who wish they had been taught these basic techniques before injuries occurred.
Additionally, teach your students the importance of sitting tall (not “straight”) in one’s chair, with feet planted firmly on the floor, relaxed shoulders, and with weight distributed evenly across the seat. This will not only promote spinal health, but it will help them achieve better tone and technique (as well as help younger students be less “wiggly”)!
Encourage your students to take breaks and rest if they start to feel discomfort in their joints. Whereas occasional muscle “burn” in the corners of the mouth/embouchure is not a safety issue, feeling pain in the back, neck, or extremities is. Remind your students that pain occurs when their body is telling them something important. Foster an environment where students feel safe telling you when something doesn’t feel right, and never encourage a culture where students should “play through the pain” when experiencing musculoskeletal discomfort.
While most music educators don’t have an educational background in physical therapy or medicine, we should perhaps be similar to an athletic coach in regard to the health of our students. We can positively impact the physical health of our young musicians through an awareness of the resources available (including excellent videos, adjustable nests straps and thumb rests, and wonderful articles on injury prevention by authors such as Mary Druhan, Christine Guptill, and Christine Gaza) and sharing this knowledge with our students in a manner that is appropriate to each setting.
About Dr. Goranson
Dr. Todd Goranson is a Professor of Music at Messiah University, where he teaches applied saxophone, applied bassoon, as well as coursework in music theory, jazz, and music entrepreneurship. He previously served on the faculties of Texas A&M University-Commerce and Frostburg State University. Lauded by Fanfare Magazine as “an agile and characterful soloist”, Goranson has enjoyed a performance career playing saxophone and bassoon in a wide variety of settings and genres. In addition to his own performing groups, he has appeared in concert with a diverse list of artists including Ray Charles, The Temptations, The Four Tops, Johnny Mathis, the Jimmy Dorsey Orchestra, Sandi Patti, Keith and Kristen Getty, and he performed extensively with the Billy Price Band.
His saxophone engagements include performances with the Utah Symphony, Dallas Wind Symphony, Harrisburg Symphony, Plano Symphony, Philadelphia Wind Symphony, and many others. As an orchestral bassoonist, he has played with nearly twenty professional orchestras in the US, Mexico, and China. He has performed under acclaimed conductors including Thierry Fischer, Stuart Malina, John Nelson, Marvin Hamlisch, Michael Butterman, Larry Rachleff, Delta David Gier, and Jerry Junkin. Goranson served as principal bassoonist for the Plano Symphony and Irving Symphony, and was member of both orchestra from 2002-2012.
Dr. Goranson is a founding member of the Junction Saxophone Quartet, Triforia Winds, and Trio Atlantis, and he has given recital performances and/or clinics at numerous conservatories, universities, and schools throughout the U.S. as well as Puerto Rico, Canada, the United States. He performs regularly for events such as International Saxophone Symposiums, NASA Biennial Symposiums, and International Double Reed Society Conferences. Other solo and chamber performance venues for Goranson have included Zhengzhou University (China); SMM Sommarmusikskola in Jonkoping, Sweden; The Conservatory of Music of Puerto Rico; Mahidol University in Bangkok, Thailand for the World Saxophone Congress XV; Birmingham Conservatoire in Birmingham, UK, and Mont’kiara International School in Kuala Lumpur, Malaysia.
Dr. Goranson gives dozens of single reed and bassoon clinics to grade schools and secondary schools throughout the mid-Atlantic region each year. He has presented lectures on conditioned response and coping with performance anxiety at universities and educational conferences throughout the US, including the 2015 TMEA Conference (San Antonio, TX), 2013 IDRS Conference (University of the Redlands) and 2012 NASA Biennial Symposium (Arizona State University)
Dr. Goranson’s major teachers for saxophone include Robert W. Miller, Curtis Johnson and Barry Bergstrom, with additional studies with Andy Wen. His bassoon teachers have included Ronald Klimko, Terry Ewell, Susan Hess, and Winston Collier.
Dr. Goranson is an artist/endorser for Yanagisawa Saxophones, Conn-Selmer, Inc., Hercules Stands, and is a Vandoren Paris Artist-Clinician.