The problem is often not pain
A musician can be in no pain at all and still be injured. Slower fingers, a vibrato that has gone stiff, an embouchure that fails in the third hour, a tremor that appears only on stage — these are injuries, and they need to be examined as injuries.
What performing arts medicine is
Performing arts medicine is the field concerned with preventing, diagnosing and treating injuries in musicians and other performers, and with getting them back to performance afterwards.
The physical demands on a performer are not the demands placed on the general population, and this changes what a useful examination looks like. A general musculoskeletal assessment asks whether you can raise your arm. A musician's assessment asks whether you can still control the third finger at speed in the fifth position after ninety minutes — which is a different question, and often has a different answer.
So the goal here is not only to relieve pain. It is to restore functional performance, improve movement control, rebuild endurance, make your use of the body more efficient, and get you back on stage safely. This is where the art of medicine meets the art of performance.
Where the demand actually falls
The same word — "shoulder pain" — describes completely different injuries in a violinist, a trombonist and a pianist, because the structures being loaded are different. Start with your own instrument family.
String players
Violin, viola, cello and double bass. Vibrato, finger speed and independence, bow control, tremor, and the neck, shoulder and interscapular problems that come with holding an instrument up for hours.
Strings 02Wind & brass players
Embouchure control and endurance, air leakage, tremor and asymmetry around the mouth, breathing and air support, jaw and dental factors, and the neck and hand symptoms that follow.
Winds & brass 03Pianists & percussionists
Dynamic range, balance between the hands, trills, finger independence and collapse, and pain or fatigue through the neck, shoulder, back and upper limb.
Keyboard & percussionWhen practice and stage are two different people
Some musicians notice a large gap between how they play in the practice room and how they play under performance conditions:
- Becoming tense or losing focus on stage
- Hand tremor or reduced control that appears with anxiety
- Unexpected breakdown during an audition, competition or concert
This is worth examining rather than simply enduring. Performance anxiety and physical injury are not separate categories in practice — a tremor may be anxiety, may be a nerve problem, or may be anxiety layered on top of a nerve problem that has made the hand unreliable and therefore frightening. Distinguishing between them changes the treatment entirely, and it is one of the things a musician-specific examination is for.
Before your visit
- Bring your instrument if you possibly can. Much of the examination depends on watching you play, not on watching you lie on a couch.
- For large instruments — double bass, piano, harp, large percussion — record video of yourself playing or practising in advance instead.
- If you are preparing for a competition, audition, recital or examination, early assessment is better than late adjustment.
- For a check-up before an important international engagement, schedule the evaluation three to six months ahead. That is enough time to change something safely.
Tell me what has changed in your playing.
Email your symptoms, how long you have had them, and a short video of you playing. I reply personally, and I will tell you honestly whether I think I can help before you book anything.