Injury Prevention and Healing through Yoga

How yoga can alleviate—and prevent—the aches and pains of string playing

by Lauryn Shapter


 

Practioner Tracye Lederer demonstrates the basic Mountain pose.

At the 100th anniversary celebration of the Berlin Philharmonic, the late Yehudi Menuhin conducted the opening of Beethoven's Fifth Symphony. What was unusual about it was that Menuhin conducted with his feet while standing on his head, a trick he learned from many years of practicing the ancient art of yoga.

A dedicated student of the Indian yoga master B.K.S. Iyengar, Menuhin was keenly aware of the benefits of yoga, particularly for musicians. He was introduced to Iyengar in the early 1950s when, during a concert tour of India, he developed severe muscular pain. Menuhin became a regular practitioner of the art, inviting Iyengar to come travel throughout Europe in 1954 for his first yoga demonstrations in Switzerland and France.

My own discovery of the benefits of yoga for string players came quite by accident, almost ten years after I had left graduate studies in violin performance at the Manhattan School of Music because of a severe and persistent case of tendinitis in my left wrist. I had sought the advice of various medical professionals, from hand surgeons to neurosurgeons to physical and sports therapists to acupuncturists. I had explored myriad ways to play, altering my left-hand position, adjusting my playing posture, and trying new chin and shoulder rests. After eight years and only minuscule progress,

I became convinced there was nothing I could do to play without pain. I decided to leave the profession altogether.Unfortunately, mine is not a unique story. Career-ending injuries are all too common, particularly among string players. Although it is certainly not the only path to prevention and healing, the benefits of a regular yoga practice now seem all too obvious to me–yet it is an option of which many musicians are unaware.

In the forward to Iyengar's Light on Yoga (see sidebar, page 38), Menuhin writes that yoga is "a technique ideally suited to prevent physical and mental illness and to protect the body generally. . . ." This "ideal technique" not only serves to prevent physical illness, particularly the kinds of physical problems brought on by playing a musical instrument, but also assists in the healing of overuse injuries.

To understand why yoga is so helpful, it is important to understand why a seemingly innocuous endeavor like playing an instrument is potentially so dangerous. Regardless of the type of instrument played, the muscular and skeletal systems are considerably compromised for long periods of time. Elevating the arms not only causes contraction in the muscles but also interferes with healthy blood circulation. The manner in which the violin and viola are held puts a significant strain on the neck, and the twisting action of the left arm further constricts blood flow.

Downward-Facing Dog (above) and Upward-Facing Dog (below) are especially good for string players.

Not only is the body in general compromised, but musicians tend to use their bodies asymmetrically. This is most noticeable with the violin and viola, but is evident with the cello and bass as well. In addition, certain areas of the body (the arms and hands, for example) are given a rigorous workout during playing, while other parts remain relatively dormant. Sitting or standing for extended rehearsals or practice sessions, without the benefit of significant lower-body movement, further increases general stiffness.

Because of the wrist's easy flexibility and mobility, compounded with the hand positions string players use, injury often occurs there. But the locus of pain may not be where its root cause lies; often, the diffi-culty in finding this root cause makes it harder to zero in on a cure.

So much for the bad news–news with which most musicians are already quite familiar. The good news is that yoga offers a counter effect. Although there are eight "limbs," or branches, to the art of the yoga (such as meditation and breathing techniques), the focus here will be on the third limb, the asanas (physical postures) of yoga.

Over the years, the practice of yoga has earned a well-deserved reputation as an antidote to stress, primarily due to its focus on conscious breathing and deep relaxation. Many people, however, are unaware of the deeper physical benefits of this ancient art. Because yoga is a whole-body system, the asanas exercise virtually every part of the body and intentionally incorporate the mind and spirit as well, making it a system unlike most exercise programs.

Dr. Gail Dubinsky, a physician and yoga instructor in Santa Rosa, California, specializes in soft-tissue orthopedics (the kind of repetitive stress injuries common to musicians, such as carpal tunnel syndrome and tendinitis). She uses yoga extensively in her practice and has developed a program called "RSI? Rx: Yoga." As Dubinsky explains, "Yoga works on posture and balancing the tension in the upper body. The standing poses ground you and take away excess energy blocked in the upper body."

Musicians often react with great skepticism (and sometimes disdain) when I've spoken about the role yoga has played in my recovery. Unfortunately, many believe that yoga requires tremendous flexibility and the willingness to twist oneself into pretzel-like positions while chanting something unintelligible. Contrary to popular opinion, the art of yoga (if not every pose in yoga) can be practiced by people of any age or fitness level.

Strengthening and stretching poses include (from top) Warrior pose I, Warrior pose II, and Triangle pose.

"People ask me what poses are good for carpal tunnel syndrome, what are good for tendinitis," says Dubinsky. "With a few exceptions, all the poses are good. A lot of people have a limited range of motion, so sometimes adaptations are necessary."

One of the most basic and fundamental asanas in yoga is Tadasana, or Mountain pose. A seemingly simple pose, Tadasana works on standing posture, teaching the practitioner to balance body weight evenly from the front to the back of the foot, as well as how to center the weight evenly between both feet, rather than leaning on one foot or the other. It also teaches proper alignment of the spine and pelvis, which, with regular practice, creates a postural awareness that translates to everything you do, from washing dishes to playing your instrument. Improved posture allows the skeletal system to do its job of supporting the body, preventing the back muscles from straining to maintain proper posture. I have found that improved posture has been paramount in helping me work through long practice sessions without excessive muscle fatigue.

Standing poses are the foundation of any yoga practice. Poses such as Uttihita Trikonasana (Triangle pose), Uttihita Parsvakonasana (Extended Side-Angle pose), and the three Virabhadrasana (Warrior) poses all contribute significantly to strengthening and stretching the lower body. Taking care of the lower limbs helps maintain healthy circulation; the benefits continue even while the legs are relatively inactive.

These poses also offer tremendous benefits to the upper body. The first two Warrior poses and the Triangle pose create an openness and expansiveness in the chest; relief for stiffness in the shoulders, neck, and back is immediate. The Extended Side-Angle pose lengthens the spine in an intense stretch that extends from foot to fingertips.

According to Patricia Walden, director of the B.K.S. Iyengar Center of Greater Boston (240-A Elm St., Somerville, MA 02144; [617] 666-9551), if you can find time to do only one pose, it should be Adho Mukha Svanasana, or Downward-Facing Dog, as it gives many of the benefits of the other poses. This pose resembles a dog when it is in play stance, its front legs extended forward and back legs straight. When doing this pose, the hips are raised and the body creates an inverted V, with the torso and arms in line. The fingers are stretched wide open and placed flat on the floor, creating a much-needed counter effect to the left-hand finger action used while playing. Downward-Facing Dog is also excellent for relieving stiffness in the shoulder-blade region; it is a pose I use frequently during breaks in rehearsals or when I have just finished practicing.

The opposite pose, Urdhva Mukha Svanasana (Upward-Facing Dog), is a mild backbend in which the spine arches backward and the face points upward. Like all backbends, it opens the chest, strengthens the spine, and relieves back strain. It also counteracts the effects of long practice sessions, by stretching the arms, legs, back, and neck.

Yogic breathing techniques are also considerably helpful in the healing of injuries, although they are not typically taught to beginners. "Abdominal breathing evokes the relaxation response, which promotes oxygenation and healthy blood flow," says Dubinsky. "Better blood flow improves healing."

There are literally hundreds of asanas in existence, and the explanation of them is beyond the scope of this article. In general, they can be divided into several basic categories: standing poses, forward bends, backbends, inverted poses, and arm balances. Each group of poses can benefit string players and, used together, they offer a total-body workout. Standing poses are, again, the foundation of a yoga practice. Forward bends help lengthen the spine and stretch the legs, while backbends counteract the effects of poor posture and hunching. Inverted poses help improve circulation and give relief to the legs after long periods of standing, and arm balances are superb for upper-body conditioning.

More strengthening and stretching poses include Warrior pose III (above) and Extended Side-Angle pose (below).

Besides the more obvious physical benefits, yoga has a subtle advantage over many other forms of exercise. Its union (yoga means "union") of the mental, spiritual, and physical helps people manage stress, improve their concentration, and create balance. Musicians, with unorthodox working hours, hectic schedules, and the mental and physical demands of performance, can become victims not only of playing-related injuries but also of stress-related diseases. In relieving accumulated and immediate stress, yoga reigns supreme.

Any musician struggling with a playing-related injury should seek medical help. But a musician often needs to assume responsibility for his or her own healing. The real beauty of yoga is its ability to help prevent injury in the first place, by offering counter movements that relieve current physical strain and years of accumulated repetitive motions.

I am not an advanced practitioner of yoga, nor am I a doctor or a physical therapist. I am a musician who finally found a way to play without pain, through my own internal investigation of how my body works, my own exploration into listening to the wisdom of my body. I tried yoga out of curiosity, without the slightest inkling that it would be the path that returned me to music. But the more I practiced yoga, the easier my playing became, until one day I realized how long it had been since I had suffered that crippling pain in my wrist. And nearly ten years to the day after I came to the conclusion that I would never again play without pain, I made the decision to again allow music to be the primary focus of my life. Yoga gave me a way back to my very first love–playing the violin.

GETTING STARTED WITH YOGA

There is a plethora of yoga styles available to those interested in developing a practice. B.K.S. Iyengar, Yehudi Menuhin's teacher, has developed a precise and safe method of learning yoga that uses props (such as blankets, blocks, and straps) to help beginners learn the poses. The ideal way to learn yoga is with the assistance of a certified teacher. As with any learning situation, different people are comfortable with different teaching styles–trust your gut instincts when choosing a teacher. In most metropolitan areas there are many teachers to choose from; even in remote areas, the number of yoga teachers is growing steadily. The Yoga Journal Source 2000 can be found on-line at www.yogajournal.com or can be ordered by calling (800) 436-9642, as can the Yoga Journal books and videos listed here.

If classes are not given locally, if your schedule makes it difficult to attend classes, or if you simply prefer the privacy of your own home, there are a number of videotapes and books available. Below is a partial list of resources. Remember, though, that executing the poses correctly is critical; it is best to take a weekly class.

How to Use Yoga, by Mira Mehta (Rodmell Press). Extremely user-friendly: step-by-step guide to 41 poses chosen especially for beginners. Outlines a ten-week course and includes a section on asanas for common problems.

Light on Yoga, by B.K.S. Iyengar (Schocken Books, New York). First published in 1966, Light on Yoga is considered by many to be the bible of modern yoga. Extremely detailed descriptions and photos, but may be overwhelming to beginners.

A Matter of Health: Integration of Yoga and Western Medicine for Prevention and Cure, by Dr. Krishna Raman (Eastwest Books [Madras] Pvt. Ltd.). This is an excellent and thorough reference book for anyone interested in the theraputic benefits of yoga. Although not easy to obtain because it is not published in this country, it is well worth seeking.

R.S.I.? Rx: Yoga!, by Dr. Gail Dubinsky (available from www.rxyoga.com or [707] 829-7596). This video is a guide to healing carpal-tunnel syndrome and other overuse injuries of the hands, arms, and upper body. Dubinsky specializes in soft-tissue orthopedic injuries and is a yoga teacher as well.

Yoga Journal's Yoga Practice for Beginners, with Patricia Walden. This videotape and written practice guide provide a clear, concise introduction to yoga. Poses are explained in detail and repeated several times for thorough understanding.

Yoga Journal's Yoga Practice for Strength, with Rodney Yee; Yoga Journal's Yoga Practice for Flexibility, with Patricia Walden. These videotapes build on Yoga Practice for Beginners and are excellent for advancing your practice.


Photos by Lauryn Shapter.

Excerpted from Strings magazine, November/December 2000 , No. 90.


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