BY CHANTAL NGUYEN
Did someone call a doctor?
Yes – we did!
With lockdown radically changing our lifestyles and practice habits, we grabbed our phones and dialled in “Dr Cliff”, aka Dr Cliffton Chan, award-winning performing arts medicine expert and clinical practitioner.
Dr Cliff has been working long hours getting his university online during COVID-19. But he took a break to give us tips on keeping in good playing shape during lockdown, and avoiding playing injury (because nobody wants to get injured during a pandemic).
Hi Dr Cliff, thanks for Zooming in. Let’s get right down to business: how does lockdown affect musicians’ health?
Some musicians are practising a lot because they suddenly have time for it. Others have suddenly decreased playing load and intensity. They’re not performing anymore; and when you perform, you play at higher intensity. They might not be practising as much because suddenly they have to look after the kids and do things around the house, or they no longer have auditions and performances to work towards. And that’s a concern. When musicians stop playing, they start feeling niggles. And then, when they return to their normal playing load suddenly, that’s where we start to see problems.
So how can musicians stay physically healthy when considering these new behaviours in isolation?
Musicians are probably wanting to take up physical activity and exercise during lockdown. Those are really good things to work into your day. Incidental activity through the day is important, like simply getting up off your chair every 30 minutes or choosing to stand during a Zoom meeting. It keeps up normal levels of activity, since before lockdown you’d walk to the bus or train stop, up and down stairs, things like that.
Regular cardiovascular exercise is crucial during this time. It keeps your musculoskeletal system healthy by optimising oxygen supply and other metabolism processes. This allows for better playing endurance and muscle repair. Especially during COVID-19, anything that maximises your immune system is important and exercising your heart can certainly do that.
What about music-targeted exercise?
What’s not common knowledge is that musicians should do musician-specific exercises that support their instrumental playing muscles. These are usually deep muscles that stabilise and support playing – if you’re a violinist, the muscles between your shoulder blades and deep in your neck, for example. The stronger these support muscles are, the more effortless your playing will be, and the less likely you are to develop performance-related problems.
For musicians learning new skills during lockdown, like picking up a new instrument, in short bouts this is great. But not when done too intensively, because it places new demands on your muscles and joints that could cause discomfort.
What about warm-ups?
These are crucial. Apart from strengthening exercise for your support muscles, it’s key to do physical warm-ups without your instrument first, immediately before you play or practice.
Warming up prepares your body to meet playing demands. It increases muscle temperature, nerve conductivity and muscle ability to consume oxygen. It means when you do play, you’ll feel less exhausted, and be able to play at the same level of intensity but with less effort.
Wait – did you just say warm up without your instrument?
Yes. Our advice is if you can warm up off the instrument, and save your playing muscles for real playing and performance, do that.
What about the usual warm-up – scales, tone exercises, things like that?
I’d think of that as part of practice. They should be the start of every practice session after your off-instrument warm-up. Start with easy music drills, scales, and lighter music passages.
Right. So how do we do this preliminary off-instrument warm-up?
Start by warming up all the muscles you’ll use for the instrument. If you’re a string player, warm up your shoulders, arms, neck, and back. Get your arms going by doing some shoulder circles to the front and out to the side, reach up and down, flex and extend your elbows whilst turning your palms up and down. Bend down slowly to the floor and back up again, and march on the spot bringing your knees to 90 degrees.
If you’re a brass or woodwind player, I’d add a few facial muscle and deep breathing exercises. Especially as we approach winter, this is quite important, as clinically I see sports injuries relating to lack of warming up.
How long should these warm-up be?
Your first practice session of the day, I’d do a full 10 minutes, focusing on all the joints related to your playing. If subsequent bouts of practice aren’t more than 30-45 minutes apart, you could do a shorter 5-minute warm-up.
Wow. I knew warm-ups were good, but didn’t know they were that essential!
Agreed. There’s a study on 15-minute warm-ups, where researchers had one group of violinists do a cardiovascular warm-up: a brisk walk. A second group did core muscle exercises: abdominal planks, glute bridges etc. A third did musical drills on their instrument: the traditional ‘warm-up’. And then the control group just sat there and did no warm-up.
The researchers found in performance the muscles worked equally hard for all groups, but the musicians who’d done warm-ups reported their ‘RPE’ (‘ratings of perceived exertion’) – how hard they felt they had to work to play – were much lower. So doing any type of warm-up is beneficial. But like I said, if you can warm up off your instrument, do that.
And once you’ve finished practising, don’t forget cool-downs – without your instrument – too.
What about suddenly increasing practice in lockdown?
You need to increase in increments. I’d advise not to increase by more than 5-10 per cent per week. So if you’re playing 20 hours one week, you wouldn’t increase to more than 22 hours the next week. That data comes from sports medicine, where if we increase by 5-10 per cent in duration or intensity, we see a nice improvement in endurance and performance measures, and no significant increase in risk of injury.
Most professional musicians don’t have a problem sustaining 20-30 hour playing loads if they have slowly accommodated to it. It’s the sudden increase that’s the problem.
Do you have any tips for resting between practice sessions?
Take more regular breaks. Don’t play in long bouts. Every half-hour, take a 5-10 minute break. This lets your muscles replenish their energy stores, and lets your brain take a mental break which helps with learning.
What about stretching-type exercises?
Remember the more playing you do, the more exercise you need to counter the asymmetrical and often static instrument-playing postures you adopt –. for example, if you’re playing the flute, your head is tilted and rotated all the time. So you need to move those neck joints into full rotation and side bend in both directions.
You should do more exercises to optimise your joint range and ensure the muscles holding you statically aren’t overactive or shortened. Doing dynamic stretches and even light strengthening exercises through range is important to target these problems, otherwise your asymmetrical problem might become more apparent during lockdown.
What if we get injured during lockdown?
If it’s an acute injury, always do your first aid. So you ice it, and compress it with a compression stocking. Then try not to move your injured body part excessively – you want relative rest. Decrease your playing as much as you need for it not to hurt for 1-2 days, and this could mean not playing on the first day of injury. I would then slowly increase your playing by 10 per cent afterwards.
If you feel pain whilst playing, try playing something easier, or lighter and less intense, or practise for shorter periods. But playing a little bit, even just 5 minutes, is better than nothing. We usually don’t advise a complete break from playing because that can make things worse. If it’s a muscle, try to move it within the pain-free range a few minutes every hour, but keep it generally still.
If it doesn’t get any better within 5 days, or gets worse, see your GP or health professional. Most of us are still working during lockdown! If you’re a high-risk group [for COVID-19], don’t come out, we can treat you with telehealth. A lot of physios, speech pathologists, and GPs have moved to telehealth during COVID-19. So we’re still here, and there’s a lot we can do to get you better without having to lay our hands on you.
Thanks Dr Cliff. Anything else we should know?
We also have to acknowledge the importance of psychological health and wellbeing, a huge concern during this entire period of lockdown. There are high levels of anxiety amongst musicians, about their job security and prospects, work travel and gig plans, how life is going to be, and the global impacts this will have. Immediate concerns are uncertainty from changes in lifestyle and inability to make plans. These are really important matters, and it’s very understandable they can become distressing.
If it becomes unmanageable, there are support helplines such as. Beyond Blue and Lifeline, and psychologists who can assist.
Medical Disclaimer: The information in this story is of a general nature, and not intended to provide specific medical recommendation or advice. If you have any pre-existing injury or medical condition, you should consult an appropriately qualified health professional before undertaking any exercises. If you develop any physical discomfort as a result of performing any exercises, such as those discussed in this interview, you should stop immediately and consult an appropriately qualified health professional.
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