Recently I was asked to do an article for Flute Specialists (who happen to feature a LOT OF articles by people who specialize in performing arts health. Here’s a link to my article on their site (definitely recommend checking them out) and here is the article in its entirety.
One of the relatively few studies done on strength training and playing-related musculoskeletal pain, done in 2017, found that up to 93 percent of professional musicians experience playing-related pain. A recent 48-hour poll of flutists showed that out of 30 respondents, 28 reported playing-related pain or injury. Corrective exercises and strength training have been shown to reduce or prevent these.
Three of the most common areas of pain concern the shoulder, neck, and wrist. We are quick to stretch what feels tight, but often, the site of pain is not necessarily the source of pain. For example, pain in wrists or felt as carpal tunnel syndrome is actually often caused by chronically tight or overactive forearm muscles that bring swelling in the wrist region. Additionally the core, which ties everything together (and in this case we are talking about the transverse abdominus and glute, which provide deep stabilization) is frequently underactive, contributing to everything from back to hip to shoulder pain. Within my 10 years of training, I’ve seen this weakness in almost everyone, including flutists, who can sit—holding up a flute, sometimes a heavy one—for hours at a time.
From a veritable infinite list of possible exercises, I suggest these four “no equipment” options that can be done backstage or in the practice room. A general rule: Stretch first, then strengthen.
Put your arm in a doorway with your elbow at 90 degrees. Squeeze your shoulder blade back and down toward your low back and twist your body away from the door. If you don’t feel much, try bringing your arm up higher. Hold for 30 seconds.
Facing a flat surface with your elbows straight, turn your fingers toward your body and lower your arms until the tops of your hands are flat on the table, if possible (If they don’t, do not force them; take them to maximum stretch and hold gently.) Touch your fingers and thumbs together; try to lift your knuckles off the table. This should not be possible. If you can do this, more than likely you are leaning too far forward or your elbows are bent. Hold the stretch for 20 seconds, rest 10 seconds, and hold 30 more seconds. Come out of the stretch gently.
The Upper Back/Shoulder
The “shoulder” can mean a lot of things, but most often when I hear of shoulder pain the area being referenced is on the inside of the shoulder blade, a muscle called the rhomboid, that brings the shoulders together towards the spine. Frequently, this muscle gets overstretched because the chest muscles (and neck, see bonus) are overtight, causing the rhomboids to yell in pain. If you press on this muscle and it doesn’t feel better, this may be because it needs to be strengthened. To do this stand with your feet hip width apart, knees slightly bent. Push your hips backwards keeping your spine neutral. Arms should be in front of your body with palms pointing forward. Raise your arms straight out to the side with thumbs pointing to the ceiling, keeping shoulders away from your ears and think about bringing the bottom of your shoulder blades together. Do 15 times.
The Core: Deadbugs
Lie on your back, with knees bent and feet flat. Pull your belly button toward your spine and mash your low back into the floor. Raise your arms overhead and drop them alternately behind your head. This is enough for some people, but if not, lift both legs to a 90-degree angle and drop one heel toward the ground at a time.
Bonus: The Neck/Shoulder
Flutists are unique in that to play the instrument, they not only turn the head to the left, they also somewhat tilt it forward and down to the right. Two muscles that tend to get overused in this situation and cause problems are the sternocleidomastoid (SCM) and the levator scapulae. The SCM is attaches to your collarbone near your sternum and inserts on the skull just behind your ear, turning the head and also flexing it forward. The levator scapulae muscle attaches to the upper part of the shoulder blade on the inside and goes up the neck, where it inserts on the C1–C4 vertebrae of the neck, where it helps shrug the shoulder upwards. In our forward-head-posture society, this muscle can become shortened while one SCM becomes tight and the other weak. They may cause headaches, pain in the back of the neck or pain on the inside of the shoulder blade (the rhomboid muscle). These two muscles, combined with tight chest muscles, can cause the rhomboids to become weak and overstretched, causing pain. Relaxing these and strengthening the rhomboids can be the trifecta to bring the upper body back into balance.
Disclaimer: This article is not intended to treat or diagnose, and its language been simplified.