Violin neck pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Information, in part, from the Arthritis Foundation

Violin players are probably at increased risk for developing repetitive stress injury.

The areas that are involved in performing when playing the violin include the back, the head and neck. Depending on whether the performer is sitting or standing while playing the legs and low back must be considered.

String instrument players typically complain of stiffness, pain, soreness, or numbness in the shoulders, fingers, hand, neck, and wrist.

Musicians who play string instruments often develop muscle-tendon pain from repetitive movement.

Viola and violin players can suffer microscopic tears of the rotator cuff.

In a medical paper about performing arts injuries, Dr. Alice Brandfonbrener says players may develop physical problems if they habitually raise their shoulder or press down with their neck and chin to lift and stabilize the instrument. "The tension developed from this maneuver appears to set the scene for the development of overuse syndromes," says Dr. Brandfonbrener. These can include carpal tunnel syndrome, thoracic outlet syndrome, and tendinitis.

A shoulder rest eliminates the need to raise the shoulder to bring the instrument closer to the jaw. This helps maintain correct posture and places less stress on the neck.

A shoulder rest that stabilizes both the shoulder and the violin also reduces the amount of downward pressure the violin player needs to exert with their jaw. This tends to help alleviate jaw pain.

Many arts medicine professionals say devices such as shoulder rests are an effective way to help prevent injury. "Instrument modification itself may provide a solution" to the problem of playing-related physical problems, says Miriam Daum in "Musculoskeletal Problems in Musicians".

In an interview with The Strad, orthopaedist Stephan Scharf agrees. "Accessories can make a big difference, so I have a number of chin- and shoulder-rests that a player can try." And Dr. Alice Brandfonbrener cites "the selection of a specific model shoulder rest" as a way to address problems as far removed as the hands and wrists.

Considering the possibilities they offer for greater stability and comfort, however, it seems that chin rests can be useful ergonomic devices.

There is one group of players that already appears to regard chin rests this way: those with exceptional physical traits, such as unusually long necks.

Shoulder rests also are helpful. This is an excerpt from Kennedy violins blog..."Once a shoulder rest is properly positioned, the violin/viola can be brought to the shoulder and the chin simply drops into a naturally comfortable position to hold the instrument in place. The most incredible thing about a shoulder rest that is being used correctly is that the left hand can now simply drop down to the side of the player’s body, and the instrument is still held securely (and comfortably) in place. The left hand is now free from holding the violin up into place and can simply maneuver the notes, especially while shifting between positions."

On another note (ha-ha!!), a common skin condition experienced by violinists and violists at both the amateur and professional level is "fiddler's neck," an area of hyperpigmentation and lichenification on the left side of the neck, below the angle of the jaw. Erythema, scaling, cyst formation, scarring, and inflammatory papules or pustules also occur.(Peachey RD, Matthews CN: Fiddler's neck. Br J Dermatol 1978; 98:669-674)

Acta Odontol Scand. 1996 Aug;54(4):271-4.

Signs and symptoms of temporomandibular disorders in adolescent violin players.

Kovero O, Kononen M.

Department of Dental Radiology, University of Helsinki, Finland.

Signs and symptoms of temporomandibular disorders (TMDs) and the frequency of radiologically observed abnormalities in the condyles of temporomandibular joints (TMJs) of adolescent violin players (VP group) were investigated in a group of 31 music students and in their age- and sex-matched controls (C group). All subjects underwent a routine clinical stomatognathic examination, a standardized interview, and radiography of the condyles. The VP group reported a higher frequency of the subjective symptoms: pain in the TMJ when chewing, a feeling of stiffness in the TMJ, and clenching of the teeth. Clinically, the VP group showed a greater range of maximal protrusion and of maximal laterotrusion to the right, and a greater frequency of deviation to the right on opening. They also showed more palpatory tenderness in the masticatory muscles and pain in the TMJ on maximal opening. The number of playing years and the number of weekly playing hours correlated with several signs and symptoms of TMDs. In terms of radiologic findings in the condyles of the TMJs there was no difference between the groups. It is concluded that intense violin playing may have a predisposing role in the etiology of TMDs in adolescence.

Editors note: Jaw pain can develop in kids who play the violin too much. I wish I knew about this study when I was a kid so I could show it to my parents and warn them of what might happen. But I didn't so I still had to practice... oh well...

An awareness of the Alexander Technique which aids in the alignment of the head, neck, and rest of the body may also help violin players with neck problems. (

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