Jen Cluff ~ Flute Pain Cures

Question: I've noticed lately that I have a stiff left arm and wrist when I've finished practicing. Are there any stretches I could do? I don't want to develop a musician's injury! :>)

To prevent injury you probably want to do several things:

1. Perform stretches for musicians before playing:
See: "Playing Less Hurt- An Injury Prevention Guide for Musicians" by Janet Horvath.
She shows stretches for the shower, for before practice, and for "backstage" and also while seated, at a concert.

2. Investigate your total body use using one of these resources:
Lea Pearson's book "Body Mapping for Flutists"
Barbara Conable "What Every Musician Should Know about
the Body" and possibly several Alexander Technique lessons.

3. Monitor the left arm/wrist while you're playing flute so that every few minutes you are finding a more comfortable, more natural position for the left shoulder, elbow, wrist, hand etc.
If you need to relieve static pressure on the left arm from pushing the flute toward your face, or other changes to its position, it may be helpful to attach a foam pencil-grip to your flute where your left hand touches the flute.
I personally discovered that my left arm problems came from the thoracic pinching I was doing up by the front of the left shoulder.
If I lower my left elbow and change my over all posture (foot-position and balance) I can prevent pains from re-occuring.

More info. on helping left-arm fatigue in the page index above
and at:

Question:
I'm new here. I'm 18 yrs. old, and after playing flute in highschool band since grade 8 (I didn't ever take it home much or practice at home) Just lately I decided to get really serious and try my luck at a a talent contest.
I practiced for about 3 hours a couple of days in a row this week and now my arm is really really sore. I can barely move it.
What is my problem? Do I have to ice it or something? I really want to be in the contest. It's in two weeks.
_____________________________
Jen replies:
It might have been the sudden bout of practicing that hurt your arm.
It's almost guaranteed that if you go from hardly practicing at all to DRILLING a piece of music over and over again that you will strain some muscles or tendons, and end up with aches and pains.

The problem is that you don't know this until it's too late and it really hurts.
Had you known this was coming, you probably would have divided your practice time up more leisurely, instead of trying to CRAM for a talent show.

If you read on the internet about musician's injuries most occur during the following times:

- When hurrying to get ready for a big show, when practicing has been quite sparse
- When stressed around University recitals and graduate recitals
- When stressed about important competitions.

The formula that causes injuries usually includes stress, being out of shape physically, trying-too-hard because you're worried, and repetitive practicing, where you don't warm up properly, or stretch, or rest, but just pound out the music hour after hour.

If any of the above applies to you, read further, to find out more solutions.

First, tell us if any of the following apply:
Make a mental check next to those that DO apply:
______________________________
The most likely culprits for hand/arm & neck/back pain:
______________________________
Do any of these items apply to YOU? Examples below:

I never really practiced before, and now I'm practicing about 3 hours a day all at once.
Advice: If you go from "zero to sixty" without oiling a motor, you might burn the engine out.
Proper practicing starts with stretching, longtones, posture check, hand-position check (using a mirror) warmups, scales, etudes and pieces. The best practicing is done is 20 min. segments followed by resting and stretching for at least 5-10 minutes.
If you feel ANY pain at any moment in your practice, stop and rest, and use the time to sense where your body is tense, and how to relax it more.

If the pain lasts longer than three days, even when resting, consult a doctor. An arts or musician's doctor, or a sports medicine doctor may well know more about helping you than a GP or family doctor.
_________________

1. I haven't had my flute checked for leaks in over a year .
Advice: Flute pads that leak can require intense finger pressure to close each note and therefore cause hand-arm-pain. Have an expert flute repair person check your flute over thoroughly for leaks, and replace or restore any leaking pads, clean, oil, and adjust the mechanism. After this repair work, use only the lightest possible pressure to close each key.

2. I'm not really sure what "correct" flute posture is. I tend to ignore my body when I'm playing. Advice: Check out the flute posture suggestions on this website.

3. I'm not in that great physical shape/don't play any sports/don't exercise all that often. Advice: You may simply need more fresh air and long walks in order to "walk off" the stresses and tension that you build up through too many cerebral lifestyle choices. Call a good friend, and go for a walk, and laugh, and talk, and then continue to call other friends to go for walks. Walk people's dogs. Walk your own dog. Visit some beautiful parks----get out more often.

3. I spend a lot of time hunched over books. Advice: Sit in an Alexander Technique posture, and use a pile or stack of books on the table in front of you to prop the book you're reading at a slant. This raises the book like a music stand, so you don't have to hunch over it.

4. I've been staying up late and not eating all that well lately Advice:Change your diet back to one full of fruit, vegetables, and no fast food. Start making home-cooked meals. Take vitamin supplements with meals, (even if it's only a B-50 and a C-500 mg.) and start going to bed earlier.

5. I've been sick lately, and my muscles are still quite stiff Advice: Go for a hot bath, a massage, take one day off a week for the next few weeks, and just treat yourself to a fully relaxing day with no stress. Try upping your vitamin C intake and improving your diet and fresh air walking.

6. I get a lot of headaches; I think my neck might be "out" Advice: See your dentist, see a massage therapist. See if you can find a more comfortable sleeping position. Learn some Yoga stretches for the neck and shoulders. If your posture is REALLY out, look into Rolfing therapy.

7. I suspect that I'm tense all night while I sleep/grind my teeth/get up too early Advice: If you grind your teeth, and don't know it, your dentist will likely spot this sooner or later. A "night guard" can be made for you to protect you from this stressful, headache-causing practice.

8. I have had a whole lot of papers to write and exams to take lately Advice:Now that you know how stressful it can get, get determined to space your work out more leisurely instead of cramming. Start papers as soon as they are assigned, and work on them piece-meal, finishing them up to a week early if possible. Start studying for exams months in advance by synopsizing your daily class notes into study sheets each night for a few minutes, keeping a binder of study notes ready for the exam.

9. I haven't been to the dentist in a long while. (infections in the teeth can make you run down.) Advice: Make an appointment, and go once to twice a year. If you can't afford it, ask for parental help with dental bills, or a payment plan. Some Universities have student dental departments where work is cheap or free.

10. I'm not too sure if my flute's headjoint is aligned properly. My hands definitely don't feel comfy when I'm playing Advice: See articles on lining up your flute for more relaxed arms.

11. I dropped or banged my flute recently, and it's been slightly difficult to play ever since. Advice: Take your flute to the best possible technician (your flute teacher's pick) and get a "clean, oil, and adjust".

12. I grab the keys and rods when I assemble and disassemble my flute Advice: Over time this light bending through pressure on the moving parts causes the flute to malfunction, requiring extreme finger pressure to play, which leads to hand/arm and back/neck pain. Learn to only touch the smooth parts of the tube when assembling.

13. I don't really want to play the flute, I'm just trying to prove something to someone. Advice: mental conflict can lead to "trying too hard" which can lead to muscle clenching and pain. Read "The Artist's Way" a great artist's work book by Julia Cameron. It investigates all these issues, and helps you work through to creative freedom.

Summary: Take a good close look to see if any of the above apply to you, and get back to us, narrowing it down (it's really hard to not write a BOOK on this since we don't have enough specifics.)
You'll probably immediately sense which of the above you've been doing, or whether your flute teacher needs to be checking your posture (which is the next area to be checked out.)

And in the meantime, please find all my posture articles at: Posture articles on this site for flutists. You'll want to ask your flute teacher for special help in this area (or go for one lesson or more with an expert in curing flute posture/ergonomic problems with a top teacher farther afield)/

You are looking for wrists that are 'cocked back' and need to be straighter, and less tense; a non-leaking set of pads; weight distributed evenly in the body so that the legs, feet and hips are actually holding you up so your upper body is free, and non-tense arms and hands that float into place. The flute should feel buoyant.

Also, flute alignment is important as well as, for some players, getting a good balance and/or grip on the flute. Look for aligment and ergonomic articles here. You may wish to alter the way you put the flute together (Example: Change the headjoint's amount of turning in, or move the footjoint keys closer to the RH pinky) or other small changes which allows the flute to be held effortlessly, with no excess tension for any note pattern.

What you'll probably need to do is develop 20 minute practice segments where you work on the basics (tone production, breathing, posture, easy light finger changes etc.) and stretch out and rest in between.

If your arm is too sore to play at all, then ice to reduce muscles from swelling, followed by warmth are usually what doctors recommend.

Likely, if the pain is severe, you will have to take two weeks off from flute practice, consult a doctor or flute teacher who knows about arm pain recovery, and unfortunately miss the contest.

Don't risk it and hurt your arm permanently by attempting to play through th pain. It's a very very dangerous kind of injury that sometimes cannot be made better if taken too far over the pain-threshold.

When you've damaged or inflamed a part of the body, the message being sent is STOP! However most musicians don't want to stop playing. They have shows, recitals, competitions coming up. They need to keep practicing. However practicing while you're in pain can cause irrepairable damage to muscles and nerves.

So while you're resting between 5 minute practice sessions and/or using mental imagery to practice, here are some ideas to think about:

1) Yoga-type deep relaxation:

Many modern day humans walk around in a tight state of muscle tension for most of the day. Sometimes muscle or nerve pain is endemic, and what the individual needs to know is just HOW to deeply relax.

One could try a yoga relaxation tape, video, or class, where someone actually talks you through a session of lying on the floor, and beginning with the feet, relaxing each muscle one by one, all the way from the toes to the top of your head. You know, the kind of thing where they tell you: "now......let your feet
get very heavy, and the weight of them fall into the floor. Let go of each muscle in your ankle.....let go of your toes, let go of the back of your calf muscles....let go of the front of your shins.....your lower legs are sinking comfortably into the floor........etc." Until they've "walked you through" every muscle group in your body, and you're lying there like a heavy jelly-fish.

Perhaps you've never BEEN that relaxed before, and you'd need to find out what exactly it feels like. Then later, when you tense up again, you'll at least have a bodily-sensation reference point, in order to compare the tension you previously assumed when you concentrated on your flute playing, to the sensation of total relaxation when lying on the floor doing the "total body
relaxation". After all, there is no lesson more thorough than one that you FELT, all over your body completely.

2) Think about how most flute tension often starts in the fingers:
I think Michel Debost once talked about this in a Flutetalk Magazine article on body tension. He said that the tension of the whole body, neck, head (and face too!!!) often starts with "gripping the keys of the flute" and then travels everywhere else from there.
I never believed it really, until I happened to do a strange project. I was using contact cement to glue extensions onto the keys of my flute, and I was dying to test the extensions out before the glue really had a chance to dry. So I gingerly and gently picked up the flute and started to play, but I only let my fingers barely press down the keys, since I was SO worried I'd wreck my gluing-job.
Guess what?! My arms relaxed, my face relaxed, my neck relaxed, even the small of my back relaxed!!!! Debost was RIGHT!!! If you hold the flute like each key is the wing of a butterfly (or anything else you'd think of as "delicate": tissue paper for example) then you'll find alot of the body tensions disappearing in turn.
I think many of those tensions *are* compensatory.

Another Flutenet member mentioned the balancing points of holding the flute, which are also an important part of this experiment, since once the flute is balanced well, you feel that it's not going to fall out of your hands even when NO fingers are down. (like when you play C#). So ask your teacher about this, and secure your balance points, so that you can let your fingers be effortless and weightless on the keys.

3) Some imagery from a great violin teacher.
Herbert Whone wrote a great quotable paragraph about learning when your muscles are tense, and when they are light and buoyant, which I'll quote below. Perhaps the imagery will be of help to you in your general quest for muscle looseness.

Herbert Whone explains in his book "The Simplicity of the Violin" that he has his violinists tense their arms and fists into a rigid state (steely), then relax completely (air state) to guage the two extremes of muscular contraction. After becoming familiar with those two extremes, he then asked them to sense all the degrees in between:

"The exercise can be extended by increasing sensitivity to different degrees of tension.. ...it is useful to draw upon images of corresponding density from the natural world. Maximum contraction could be imaged as steel, and minimum contraction as air, and between them, in descending order...stone, soil, wood, water and paper. The middle degrees of this seven-fold scale would then correspond to the tension states that normally inhabit and inhibit the body during waking life and in the practice room. By becoming familiar with such states at the shoulder, elbows and wrists, it is possible to control and ultimately transform them at will into the *air* state. This 'feeling awareness' is then the basis for all control of the body and must be seen as the first stage in a
player's training.... it does not apply only to the arms, though of course they are of primary importance: ...The lightness of air should extend to every limb and muscle in the body until it is felt as a totally flexible unit."

4) The book called "The Physical Flute" by Fiona Wilkinson:
I have raved about this book for many a time and oft on the Flutenetto, and I will simply say that it transformed me into one of the most relaxed players that anyone has ever seen. I'm serious! I actually have people from professional orchestras tell me: "you are the most relaxed flute player I've ever seen!"

So, I'll say no more, except that I've got my book review posted on "The Physical Flute" on the "files" pages of the flutenet. Just look for it under "books for flutists (including book reviews) inside my folder called: Articles on Flute by Jennifer Cluff at: http://groups.yahoo.com/group/flutenet/files

And get a copy of "The Physical Flute" as quick as you can. The ordering info. is in the above review and on my favourite repertoire page.

You'll go nuts for this book!!!!
Alternately you'll go "jelly-fish" for this book. :>D

Also consider:
a) what does your flute teacher say about this tension?
b)And are you getting enough healthy fresh air and exercise so that you have a balanced muscle situation in your body?

(If you're a bookworm who never walks anywhere, you may have to begin a healthy walking program to increase the blood flow and to relieve mental/intellectual/concentrational obsessions :>) I know that this has helped me, since I used to just stare and think all day, and then when I practiced I'd turn into one big chrystalizing knot.
Now I walk and get fresh air BEFORE I start to practice.

Good luck, and let us know all the details of your investigative
research on this one!!!

Cheers! Jen Cluff.

Question: I'm suffering from carpal tunnel in my right wrist and tendonitis in my right thumb. <snip> I would appreciate any advice that anyone would like to give me.

Jen replies: Good. You've already consulted a doctor. But just to help based on my experience, here are some visualizations that may help you sort out just how to relax. Of course these of course don't substitute for expert medical care. It's just that between visits to doctors, we sometimes need to find our own useful images to aid recovery.

1. From the ground up.
Many muscle problems in the upper body stem from an unbalanced stance when practicing. Many of us unconsciously shift all the weight to one foot or the other, and thus throw off everything above the hips. Arm and back muscles will then strain against an unbalanced base.

So, before trying to change anything about your actual hand-grip on the flute, first make sure that you're placing your weight equally on both feet (feet should be at least a foot apart), and keep your knees flexed and elastic (don't lock at the knees.)

Travelling upwards, release any tension in the small of your back, and un-lock it as well so it feels as though your hips can swivel in small, loose figure-eights.

(Yoga stretches are also good to release the back area in general. Why not try doing a few basic ones every morning or before each practice session?)

If your knees are very slightly flexed when you play, this will help the small of the back to not tighten and lock either. In turn you'll find your back is better assembled to carry your body better.

2. Floating up and out:
Now, with your body balanced firmly on the hips, pull up and out of your hips so that your upper body can float. Let your head hang from an imaginary string, and let your upper body take up as much space as possible in a 360 degree shape.

Holding your flute, your arms also take up as much space as they want (don't pull them down close but let them "sproing" up to where they want to be. Naturally, neither do you want to raise them artificially high.)

Every time you breathe in expand all the floating ribs at the base of your ribcage, and as you exhale, leave them floating gradually inward, very slowly so they don't collapse too fast. Let this 360 degree expansion be your focus as you float upwards from the imaginary string, up, and out of your hips.

Let the sound of your flute seem to come from your heart area, and flow out the front of your body, instead of being blown from your face area, which can lead to head and neck tension. Float your flute's sound on the air, and be aware of the round expansion of your ribs and back the whole time.

More on all these concepts can be found in the book: "The Physical Flute" by Fiona Wilkinson (see the book review at my webpage with descriptions of more advanced technique books).

3. From the hands down:
Muscle problems in the hands and forearms are exacerbated by gripping the flute too hard with the fingers. So, instead, observe the actual amount of finger pressure it takes to overcome the spring that 'sproings' the flute keys back up again when they're released.
It's probably far far less tension than you thought you had to overcome to close a key.
Sense the exact amount of finger-pressure you'd need to merely overcome the spring tension of each key, and use no more than that when playing your warm-up or longtones.

Go extremely slowly at first so you can truly observe and sense each finger using less than a gram of its weight to close each key.
Move so slowly through your practice routine (do less than normal at first) so that you imprint this new sensation of finger lightness at each step of your practice.

If the tension comes back at any point...shake out your hands lightly and thoroughly until they buzz like pins and needles (as long as this doesn't hurt your carpel-y wrist) and restart slowly and unrushedly, using numbish hands, so that they don't go back to gripping the flute. Take frequent breaks in which you can lightly massage your hands and forearms to keep them aware of "letting go" of tension, and how it feels when they're 100% floppy.

NOTE: If the notes sound irregularly fuzzy in tone when your fingers are this light, please have your flute professionally checked for pad leaks. One of the commonest reasons for increased hand and arm strain is leaking pads. I really should have said: check this first!!!!

4. Hand and arms as light as air:

Here's an imagery sequence for you to try out:

Imagine that your hands and arms are made of air. Compare them to
the air that actually surrounds them, and see if you can match its quality with your muscles becoming so buoyant and relaxed that they feel 'aerated'.

Imagine the molecules in your hands and arms expanding with air inbetween so that they are so light, it takes no effort at all to use them.

In your mind's eye, see each forearm expanding in a 360 degree circle, so that they're very round and full.

See each wrist as becoming expanded by air so that each one is very round and getting larger and larger.
Let all the muscles in the back of each hand completely melt, so that there are no tensions in the hand backs at all. Let each finger float up and down onto the keys with nothing more than the smallest distance travelled necessary to open and close the keys.
In the down position, remind each finger to rise by letting go and letting the spring push the key back up.

5. My favourite idea:
Ask your body to find a way to hold and play the flute without ANY tension.
Then wait, and see what it does.
As I said in another post the other day, the body is far more knowledgable about how to achieve a given outcome than our minds are. And asking it directly bypasses many levels of intellectual experimentation and imposition.
If the problem is localized to one area...ask the body:
"Find a way to play the flute with that one area completely relaxed and free from pain."

Then wait, and see how it will do what you asked.
I love this idea the best because it's putting the body in charge and this allows it to go directly to what it needs to do.

You'll see. It's a fantastic method.
Just trust that it'll work, and it will. Right away.

Added ideas:
a) try going for 2 to 4 full body massages, so that your body isn't holding tension ANYWHERE else either, so that it can balance better when you're practicing.

b) before you go to sleep, imagine your muscles in the painful areas as places that you can completely release and relax. Spend a few minutes expanding each area with air, and even sending air to it from your lungs. Example:
Breath in, send the air to the area that's tight or painful, and breathe out THROUGH that area (as though there's a hole there where the air can be pushed through.) Do this at least three times on each tight area, and notice how the breathing out through it makes it warmer and more large and loose.

c) take hot baths when tense, or have more rests during the day.
d) avoid excessive arm use for typing or sports prior to your recital.
e) ask the doc. about anti-inflamatories for your carpal tunnel etc.
f) do less in a day, not more. See if you can adopt an attitude that rest and recovery is more important than achieving marks and getting everything done. Sometimes our bodies are demanding that we listen to them, and won't stop until we DO listen to them.

There are some more books on these topics on my "booklist for students" on the member's files pages. Have a look for "Healing with the Mind's Eye" by Michael Samuels at your local library.
It's full of meditational techniques for healing the body that are really beautiful in imagery, and really neat to do.

Gosh I wish you luck with this. :>)
Hope my "energy fields forever" ideas work...if not, I'll have to
just sing the song with the rest of the nutters, and hope that
THAT works. All the best..... Jen Cluff.

Query: I read over your article on Flutenet called "Hand & Arm Pain; what you can do about it" (Jen adds, the one on the Flutenet files articles; see the top of this page to go there now)....and found it interesting. I don't have anything to contribute, though, as I'm basically a very intermediate player who holds the flute with what could charitably be described as a "death grip" (though I do strive to hold it in a balanced fashion, so it's not wanting to fall over as my fingers shift around).
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Jen replies:
There were two main things I found, that helped loosen the "death grip" in my own playing, and they weren't the ones I expected!

I had changed my headjoint position so I was using modified Rockstro (so the flute doesn't roll inward when you let go; see descriptions below) and I had all the leaky pads fixed so perfectly that the notes on the flute sounded IMMEDIATELY from even the lightest possible finger weight on the keys.

But there were two things I really didn't expect to help that did.

The most helpful was from working with Roger Mather's advice in his 3-volume manual, "Art of Flute Playing", about lowering the pressure point of the lip plate so that it was virtually against the roots of the lower teeth.

That means more fully utilizing the quite large silver lip plate area provided on the headjoint. You'd be surprised how many flutist students I've met who only place less than 1/4 inch of the lip plate under their lower lip, and leave the whole large lip plate area dangling in space.

Investigate your own lip plate as it sits on your chin area.
Is there an air-space between the large lip plate surface and your chin?

If so, you are eliminating the natural "traction" that the flute makers have allowed you. If you do this, you have to push the flute toward you even harder in order to get it to stay still on your face. Instead, place the large lip plate fully against your chin-skin, and change the set-up of the flute to accommodate this.
Get your teacher's help for sure, as this may mean realigning the headjoint to the body and rotating the keys and rods so that they angle more forward.

The Main point of contact of the lip-plate:
Using Mather's experiment sequence in "The Art of the Flute" (outlined in his embouchure chapters) you will find that as you systematically lower the flute's point of contact, milimeter by milimeter, you find that you have more traction on the skin of the chin itself.

The flute's lip-plate is fully spanning across your chin-dip area, across the roots of the teeth that are very firm, and the moveable parts of the lower lip is free to change in subtle manners (more pouty, less pouty etc.), without being squished or restrained by the flute forced against it.

Mather then continues the experiments by asking that after you've lowered the point-of-greatest-contact of the flute's lip plate, that you gradually release the lip-plate's pressure on the chin until you're at the point of LEAST pressure and still have great tone.

It's amazing when I followed these ideas one by one, how the flute simply "balanced" better in the hands. The lip plate was just more steady, unaffected by lip shape changes, and had friction placement on the skin in the chin, a good 1/2 inch below the lips themselves. Previously, I'd been jamming just a tiny section of the lip plate against the red line of my lower lip, where it met the skin, and expecting the flute to stay there by a constant hand and arm pressure.

I not only developed a blister in hot-weather, when practicing for a show that was a few days away (practicing many sessions close together) but I also had to use tremendous tensile strength in my arms to keep the flute steady on such a small sliver of lip-skin.

The second thing that was startling to discover, was a point made in a Michel Debost Flutetalk article, where he says that flutist body tension actually can begin at the finger tips and travel all the way back up the arm, into the torso, neck and head.
Have your pads checked for leaks (by a professional) and then, using
100% non-leaky pads, ask yourself, how truly light each finger can be, and show yourself that only the weight of each fingertip is sufficient pressure to seal a pad. I'm talking about a 2 gram finger tip.
It's amazing how much more force we apply then that, when it's not required.

When I did this, it immediately resulted in arm muscles and
shoulder/collar bone/neck areas all to simultaneously relax.

I just thought I'd share these two things that really helped me loosen
the "death grip".
Who knows, they could work on others.

Cheers,

=================
Description of MODIFIED ROCKSTRO;
__________________

There are three ways of holding a flute:
___________________
A: The 4 sided flute balance (box or square shape):
In this, the headjoint is usually aligned so that the center of the
embouchure hole lines up with the center of the keys.
The flute is held on four sides by four opposing pressures:
1. The lip plate against your chin opposes...
2. The pressure of your LH index finger pushing toward your chin.
3. The right hand pinky pressing on the D# key opposes....
4. The upward pressure of your right thumb under the flute tube.
___________________
B: The full Rockstro: (triangle in shape)
In this method the headjoint is usually aligned so that the far side
of the embouchure hole lines up with the center of the keys. Some
flutists turn it in even farther.
The flute is balanced on three points:

1. The lip plate against the chin (very little pressure.)
2. The left index finger phalange is shifted under the flute so that
the flute rests on it as on a shelf.
3. The right thumb moves more to the back of the flute, and guides the
flute forward, away from the player.

This guiding motion allows the flute to swing on the shelf or fulcrum
of the left index finger, and pushes the headjoint toward the player's
chin.

C: Modified Rockstro:
This is a modified version that combines some of the features of both
of the above, but leans more toward the second.
The headjoint is somewhere between centered and far-side line-up, or
in any variety of positions after some experimentation.

1. The left index finger is somewhat more UNDER the flute than on the
side of the flute, but may assist slightly in pressing it into the
player's chin.
2. The right thumb is half-way between under the flute, and around the
back of the flute.
3. The right pinky does not press down hard, but can often be lifted, with no loss of balance.

If you wish to read more about Rockstro, see his treatise on flute playing.
For more on Modified Rockstro, see Walfrid Kujala's "The Flutist's Progress" where he writes a full two densely typed pages about how he thinks it's the greatest invention since sliced bread. :>)

For more on lining up the headjoint with the farside in line with the
key-centers see diagrams by:
Altes Method
Roger Mather's three books on "Art of Playing the Flute"
Marcel Moyse (in "Debutante Flutist" I think?)
Trevor Wye's Beginner Practise Book vol. 1 (diagrams of shelf-like LH index finger)

I think the primary reason why people change to Rockstro or Mod. Rockstro is because they've felt too much pressure on their left index finger, and perhaps a cramping in their left hand, or, alternately too much gripping in their right hand.

The fault lies with the heaviness of the rods which can over-topple the flute, and cause it to roll toward the player when the fingers are lifted.
Rods need to be balanced to stop this rolling (they should be at 1 o'clock or 2 o'clock, instead of 3 o'clock, if straight up to the ceiling is high noon.)

Hope this helps.
Jen Cluff
___________________________________________
Further experiments from Roger Mather books with your lips and tone production that can very much ease the arm & hand pressure:
___________________________________________
If you're working with "How much pressure on the lip" and "How to get
Great tone without pressure" all these individual embouchure considerations are covered in the excellent three volumes of Roger Mather's "The Art of Playing the Flute".

(if ordering Roger Mather from the library, order volume One for "Varying your tone colour" experiments.)

Here are some of the things to consider:

1. Experiments with angling the lips north, south, east and west,
and using a mirror to insure the lip-hole is centered and the
flute is parallel to the face. You'll want guidance in flexing
the lips a tiny amount in each direction so you can control the
exact angle with the most inner-lip-membrane being used and
deciding where the most comfortable postion is for the lower jaw.
(this depends on whether you have an overbite or underbite etc.)

2. Creating a long air-reed:
This is about maximizing the distance between the hole in the lips, and the striking point for the air on the far side of the embouchure hole. It's achieved by gradually lowering the pressure point of the flute's lip plate on the chin so that it goes from squishing the lower lip at the level of the lower teeth (a beginner's sound that is too short and air-reed and has no colouring possibilities) to feeling the flute's lip-plate pressure as against the roots of the bottom teeth.
(lowered pressure point of the lip plate allows freedom for the lower lip to move and reposition itself.) This is combined with uncovering more of the blow-hole in the flute in a series of experiments.
Note: The EDGE of the blow-hole still remains at the red-line of the lower lip, but the pressure of it is rotated down and out.

Many novice and intermediate players pull their upper lip too tightly against their upper teeth, so that there's no space for the upper lip to be stretched out and away from the teeth. You want the airstream to be directed by the upper lip at a downward angle, so that the flute in a low, relaxed position, can stay still while the upper lip changes its angle minutely to blow more deeply or more shallowly into the flute.

The more you are able to flex the upper lip away from the teeth, the more experiments you can proceed with.

4. Relaxing the jaw and opening the mouth cavity behind the
embouchure:
This is about creating a resonant chamber inside the mouth, even though the lips are in the "flute embouchure postion." You want to use all the resonating cavities you have (open sinus, open throat, open mouth) so that the flute's vibrations echo back into the body cavities, and create a resonance there.
(Helmholtz effect).

5. Puckering vs. drawing the lips back (lips moving together):
Roger Mather's experiments allow the individual to gradually pucker forward to see what effect that has on the tone in various registers, and then to draw the lips back again to see which is more effective for his particular dental construction and lip tension.
When I was taught to experiment with this (when I was 16) it was done by considering the position of the CORNERS of the lips, with the mind on the final feel of the lips in the center; Are they fleshy/pillowy? Or are the lip centers getting tighter and tighter?
Which amount of puckering (move only microscopic amounts at first) works for low notes, high notes, medium notes? etc.

6. Uncovering the flute's embouchure hole more or covering it
more.
This has to do with the lower lip specifically.
If the above changes are being done as experiments, many times the sound will become too "covered" as the lips are allowed to become more fleshy and more mobile. The student has to constantly check whether "rolling out 2 milimeters more than they think they need to" in fact results in a more projecting and ringing sound.

The optimal covering of the embouchure hole is between 1/4 and 1/3, and most flutists tend to cover too much as their lips become more flexible. So at every chance you get, uncover the flute's blow-hole by a milimeter or two, and listen to the sound become more open and free. (rotate the flute down and out on the chin)

7. Releasing the tension in the upper lip so that the hole in
the lips has a rounded arch in it, instead of a long thin slit.
This is the single most effective change to varying tone-colours that I've found once the other experiments have resulted in a vibrant and open sound.

This "arch in the lip aperture" also allows a quick ascent or descent into different octaves of the flute's range, without making too many other changes to the lips.

Since Roger Mather wrote nearly 105 pages with experiments in all the above areas, and since your teacher wants you to experiment......I think that all I'm able to do here, is try and interest you in trying out Mather's Vol. 1 of his "The Art of Playing the Flute".
You'll find it possibly using the interlibrary-loan function of your local library, or you can order it from www.fluteworld.com

Send more questions!!! :>)
Jen Cluff

Question: I've played the flute for eight months and have recently switched to "Rockstro" configuration which helped, but still I have real pain in the left shoulder blade area.

I figured that the muscles were weak and so have been doing pushups and lifts, and arm exercises, but the pain has only worsened. Are there any exercises on the net for flutists? I don't want to make the time for private lessons (which I guess you all will suggest) as I'm a full time grad student. I simply don't have the money.

A second student adds:
I'm experiencing the same problem with pain in the left side of my back just below the shoulder blade and also in my left shoulder. I'm trying to strenghten my shoulders with exercises (push-ups mostly), but I'm not sure what to do about my back. I tried to do "back push-ups" where I lay on the floor (facing the floor) trying to push my upper body up by using my back, but that seems to stimulate just the muscels in the lower part of the back. I do believe swiming
would be quite good though because of the arm movements.

Okay, I am going to warn both of you here. The strain you are putting
on the areas mentioned can cause permanent tearing and scaring to the
muscle-skeletal structure of the spine. Not to mention the permanent
shoulder damage. You are also doing damage to the small ligaments
within your spine that hold your vertebrae in place. This can lead to
all kinds of pain and problems and possible future surgery. Also some
incurable nerve pain/ neuralgias.

So I am going to ask:
? Are you pulling your flute too far back on the right ?
? Are you over-stretching your left arm and shoulder to reach the flute and the keys ?
? Are you twisting your body too much to the right ?
? Are you perhaps turning your head too much to the left while trying to move your body and arm/shoulder to the right ?
You really need some serious flute posture work. I would say to look into the Alexander Technique.
____________________________
Jen writes:

Dear Scapula-pain sufferers,

I played flute until the age of 24 before suffered from this pain that
you describe. I then dealt with the pain for 12 straight years, and the damage I had done was fairly irreversible, so I advise you to seek immediate help
from a specialist.

First, as the others have suggested, Alexander Technique. You cannot, as a musician, put off seeing an AT teacher. It will help your other instruments as well (piano etc.) and your voice. If you don't seek out Alexander Tech. you may well do permanent damage, because the cause of your shoulder pain could be the relationship of your head to the rest of your body.

Secondly, find a good private flute teacher, regardless of the cost, and go for at least four lessons to learn how to develop a healthy flute posture.
Without an expert analysing your holding of the flute, you may continue to experience pain, regardless of other research or exercises you do.
Holding the flute wrongly, and making it DIFFICULT to hold is very
common.
Even having the headjoint on wrongly for your hand-size and arm-position, or the simple positioning of the right thumb can affect already damaged tissues in the body.

Thirdly, deep tissue massage, myo-fascial release therapy or Rolfing are all good follow-ups, after the pain has subsided.

Because of the left arm's role in crossing the chest, various nerves and ligaments can become tightly cinched in the shoulder and neck. A deep tissue massage person can work out these tight spots, but if you neglect them, they can eventually cause pins&needles in the left arm, as well as weakness in the finger motions and hand.

All of the above I have been through, and come out the other side, 20 years later. Mind you, I now have modified the in-line keys of my open-hole to be closed hole and offset. I also have changed to modified-rockstro alignment, and changed my right thumb to the position that Galway uses. All these changes, plus reading the books "Body Mapping" by Lea Pearson and the fundamental music-posture-practice books "Playing Less Hurt".
What Every Musician Should Know about the Body" and "The Athletic Musician" . There are also good suggestions in the book "You are your instrument" by Julie Lieberman. All these books may well be in your University library, and all are highly recommended.

Best of luck,
Jennifer Cluff

Dear Flutenuts,
As to the kind of arm and hand damage that occurs from playing the flute for hours everyday for decades, I'd like to create a discussion-list of possible causes, so that our readers, and future advanced students and professionals can avoid hand and arm damage themselves.

Mind you, my knowledge of RIGHT hand damage is limited.
I've seen it but I've never had it.
Can one of our Nutters whose RIGHT HAND damage make a list of precautions that might prevent Right Hand Damage? Thanks. I feel my list, below is a little LOPsided!!! Hhahahah! :>D

But I know well some of the causes of how I damaged my LEFT hand. And hopfully, we'll someday see an article that asks Baxtresser, and John Wion (both having left-hand problems only late in their careers) and other professional flutists how much of the damage to their hands/arms resulted from the ergonomic design of the flute.

Also, who knows how long it will take for someone to do a real scientific study on this, so I think we should be fore-armed!!! :>) (Eeegad, I never thought I'd *ever* make a pun in this lifetime!!!)
Read on, please: :>)

Possible Causes of left hand damage
(based on my own experience playing 31 years; and LH damage)
Jen Cluff
_____________________________________________________

Hand or arm damage can occur in a flute player from any number of the following factors:
__________________

1. Headjoint misaligned so flute does not balance in the hands, causing chronic hand clenching to stop from dropping the flute.

2. Playing without a music stand, hunched, and sitting resulting in the arms having to take the entire weight of the flute and possibly also the weight of the head, neck, chest and upper body. Examples: Playing while sitting on a floor or bed with music laid down on floor or bed. Flutist bends over and peers to play. Arms twist and take all the weight, or rest on knees, while trying to wiggle fingers very fast.
(I was surprised how many people really do try to practice flute this way! I fear it might be very common!!!)

3. Overally poor posture (or poor eyesight) causes flutist to poke head forward and peer at the music stand. Whole body is misaligned,
with neck and shoulders taking most of the strain. Nerve pinchings and cold hands/slow blood mvmt. in arms, creates strained hand and arm muscles.

4. Pad leaks cause player to pound and press down on keys to get clear sound.
The pressure applied to each finger travels down hand, into carpal tunnel, and throoghout tendons in forearms.

5. "Out of adjustment" (similar to leaking pads) such that mechanically linked pairs of keys do not fully depress.

6. Left hand is positioned on the flute too far from the keys to remain in position over each key. Player makes darting motions with left hand that swivels the hand every time they want to close G and A keys.
Trilling from A to G becomes very difficult, and whole arm will seen to become involved during attempts at this trill. LH ring finger approaches keys straight, not bent, and reaches toward flute repeatedly.

7. Pinky of either hand is curled under the hand, or straight, pointing toward floor or ceiling. Student is trying to play flute without pinky involvement, and use only their strongest fingers. This strains the back of the hand whenever pinky is called into play.

Usually repositioning the hands so that all fingers are curved and remain over the keys re-distributes the workload across all four fingers.

8. The flutist's "Body Mapping" may be incorrect;
The mental image of how body parts are put together and levered to work can be faulty. This topic is addressed at length in "Body Mapping" by Lea Pearson. Of particular interest is the idea she put forward lately about many people mistakenly believing that their arms rotate around their thumbs.
When you realize your arms rotate around the pinky, you release the bone structure of the forearm bone that follows the line of your pinkys. This broadens the hand, and leaves more room at the wrist for tendon action.

9. Small wrists with tight carpel tunnels; this is a hereditary factor. I know little about it, but someone else might chime in on this one, and describe more clearly.

10. Trying too hard; Humans, and other animals often steel themselves to try HARDER, and unecessarily tighten muscles and force themselves to do too much in too little time, with inadequate warm-ups for the muscles.
This is one of the direct causes of sudden debilitation in the hands and arms. I'd warrant that this factor deserves a great deal of study.

11. "Military Band" flute posture may have been required of flutists, that pulls their left arm across their chest, and their right elbow behind their body, so that flute is parallel to the chest. This causes damage to the shoulder socket, and muscles in the back and scapula areas.

12. In line open hole flute may demand that a person who has a short or difficult-to-stretch left hand ring finger, may cause damage to the ligaments and tendons in the left hand and arm.

13. Accidental arm or hand strain is not rested adequately before flute playing resumes (could happen to a professional on a heavy performance regime, or to advanced students during exam time/auditions/recitals.)

14. Imperfections are HAMMERED OUT during practice time, without analysing the true problem or creating solution-pathway to technical difficulties. Student just hammers fingers for no reason other than frustration and worry.
Hammering does not work, and in fact takes longer.

Answer: Analyse problems one to two notes at a time, in piecemeal exercises, then re-construct technical problem very slowly and with great focus. Use brain-power INSTEAD of finger-hammering.

15. Student is resting first phalange of fingers on rods, and trying to lever the finger from half-way up each finger. Usually, this LAZY right hand is approaching the keys, with the ring finger and pinky straightened, from a 45 degree angle. The right thumb is typically misplaced, and the whole hand slow and inaccurate.

The correction is to, instead, having the palm parallel to the flute, each finger gently curved and the palm cupped as though to hold a small ball in the palm.

16. Thumb keys not closing properly (ex: a thumb-key designed by Mateki in the '80s) which tend to require a bent-thumb in order to operate.
Bent thumb needs to grip harder to get traction on silver, and tension goes into whole arm.

17. Flutist presses flute hard into chin area to gain control over the mouth piece.

The correction to this is to increase the sensation of traction on the LH index resting area, or on the chin itself. Sometimes a check-list of removing all other of the above problems 1-16 will fix the true reason for this face-pushing. Damage can be caused to whole left arm.

18. Flutist mistakenly visualizes pressing or lifting the flute UP when "holding" it, instead of balancing it also in the horizontal plane, by guiding the footjoint away from them, and letting LH act as a fulcrum to swing the headjoint toward the face.

19. Flutist plays too long with head tilted so that wrong muscles are holding up head as 15 lb. static weight. This nerve pinching in the neck travels downward and affects shoulders, back and arms.

20. Flutist tries hard to inhibit any and all body movement, and doesnot frequently change position, by incremental slight shifts in muscle use.
In other words, flutist inhibits ALL muscles, instead of allowing a flow of use among all muscles.

_______________________end Jen's list :>)

Right arm problem:
> I am using the modified Rockstro hold described in the articles on file at flutenet. At first I really liked it, especially not having to worry about the flute spinning when playing all holes open.

> However, now I am developing right arm stiffness while playing. I DO have to work at dissociating and at relaxing...but I DO work at it, so I know I'mnot spending a lot of time clenched and tightened.
> Specifically, my elbow and shoulder become painful and stiff while playing.It takes several minutes of stretching to loosen it after practicing for about 30 minutes.
> Could it simply be that I am working muscles that are unaccustomed to the position and movements? And that likely they will become stronger as time goes on and not become stiff and painful? Maybe just being over 40 is the problem and I just need to live with it? E.
___________________________
Jen writes:

Dear E.(and other Flutenuts with right arm corrections please jump on in too! :>)

As I once said before on this topic: changing one tiny thing about your flute posture can lead to the "butterfly effect." Any change can lead to other changes that need to be dealt with. And....
Yes, indeed, certain muscles brought into use for the first time (especially over 40 when we're alot stiffer and less resilient) can cause unaccustomed stiffness and occasional twinges, but one must STOP IMMEDIATELY if there is any hint of *pain.*

Any actual *pain* has to be listened to and obeyed.
The muscles and nerves sending the pain signal are at risk, and will
recover very slowly. So don't chance it. Stop immediately and figure
out if any of the following suggestions can be used.
______________________________________
Considering right arm/hand pain:
________________________________________
1. Right arm & hand pain occurs quickest when there are leaks in the pads sealed by the right hand. Take the flute to a reputable repair person and have them use an insertable light to look for leaks. (or a very adept technician may use "feeler" papers.) Since this costs next to nothing, it is worth doing at least every 6 months.
The flute can also be oiled during this visit, if it is found that there are no leaks to be fixed.

2. Other right hand/arm problems can be caused by pinching or contraction in the shoulder. Go to the library and get out a yoga book that shows chest expansion exercises where you clasp your two hands behind your back, and then bend forward, forehead pointing toward knees, and then gradually let your shoulders rotate backwards in their sockets so that the two clasped hands follow your forward bend, and rotate to a position over your head. Keep knees flexed. Gently hold position for a count of thirty and repeat several times before playing each day.
The thoracic region between the upper ribs and the shoulder area is
very small, and any chronic "holding" or tension in this area can cut
off blood and nerve supply to the entire arm.
A massage that centres on this upper collar-bone, shoulder area is
also recommended for flutists. (In my case this area was a problem on
my LEFT side, but anything is possible, especially if you carry a
shoulder strap heavy bag instead of a knapsack, or have had other
previous injuries to shoulders or neck.)

On the same topic (thoracic tightness) have a look at the neck position and discover how to free the neck so that you can move it while playing the flute. Too much leaning the head to the right can also pull the right shoulder muscles into strange, tense patterns.

Add a neck massage to your shoulder massage if this is the case, and take the book "Body Mapping for Flutists" by Lea Pearson out of the library to have a look at the pictures of the thoracic area and how the shoulder girdle sits on the ribcage and collar bones 'float' above all.

Another great book with quick shoulder stretches for flutists (suitable for a lighter stretch if the person only wants to stretch the shoulder sockets and arms ONLY) is Paula Robison's WARMUP book.
Avail in public libraries or really worth buying. Great book!!! (longtones, scales, trills etc. nice pictures, relaxing words and fun all around.)

3. The hand position is GREATLY affected by the placement of the right thumb.
Where is your right thumb on the body of the flute when the pain happens?
Can you experiment with various positions?
Right thumb can be:
- Between the F and E key on the underside of the flute, at right angles to the flute's body, and on the thumb's tip.
- Under the F key, on the thumb's tip, with the thumb pulled well back so that it is more "back" than "under" the flute. (A cork thumb button or "Thumbalina" can really help with this position for those with either very short thumbs or very long fingers. Photos on the files pages under my name in the folder on "Hand Pain and what you can do
about it.)
- The Right Thumb can also be pointing UP the flute, parallel to the body of the flute. See Joanna G'froerer's position (also the one Galway uses) at the following link:
http://users.eastlink.ca/~jenpublicover/JoannaGfroerer2002.html

Much of the above thumb placement relies on relaxed experimentation, which may be aided by a square of Dr. Scholl's foot sponge (white rectangle with peel off back--sold in drugstores) for it's added traction.

One of the nice things about a cork-thumb-button or a square of traction adhesive is that you can continue to reposition your right thumb during a practice session without needing to profoundly change your added appliance. Several thumb positions are possible using both cheaply obtained products. Glue is removable with isopropyl alcohol.

4. "What is the right hand THINKING" it is doing?

This is my area of experimentation, taken from several sources, namely Lea Pearson, Michel Debost, and Thomas Nyfenger books. If the right hand "thinks" that what it is actually picking up a small book, lying on its side on a mantelpiece, it will form a natural position for holding the flute.
Try this: either put an actual slim book (not too heavy) on a mantle, or upright piano top, or other piece of furniture that is approx. shoulder height.

Notice that the right arm gently reaches forward.
Notice the position of the right thumb under the spine of the book.
Notice the placement of the fingers as you lift the book upward. (not too heavy a book--a slim paper back is fine.)
Notice the effortlessness of the gesture.

Now apply all of those attributes to the flute as it leans on your left shoulder (so that the weight is taken off the right hand to hold the entire length all by itself.)

Now, when holding the flute in playing position allow the right hand to THINK that it is making the same "book picking up" action.

If the flute seems too heavy on the right hand, allow the right hand to then HAND the flute to the left hand, while in playing position (your thumb may in several different positions to allow this "hand off") so as to more equally distribute the weight of the flute.

Think: "I'm HANDING the flute to the left hand just a small amount." to get the weight of the flute to be more evenly distributed between the two hands.

During play, depending on fingering patterns for various combinations of notes, you'll begin to notice over time that sometimes the left hand is holding the flute more, and sometimes the RH is holding the flute more.
It all depends on the combination of notes---and a gradual sense of balance that develops over time.

Notice especially that in order to work, the right shoulder can not be "pulling back" in anyway. The right shoulder must feel as if it's drifting the flute's end joint forward, not pulling the foot back toward the chest. In order to guide the end of the flute forward, the head and chest must be gently turned to the left.
Placing your feet in an angle to the music stand (right foot angles, to the right, outward at 45 degrees of more, left foot can point toward music stand, or also be angled to the right) and keeping hips angled to the right also help. Keep knees flexed.

5. Finally, there are two sets of muscles used to make the fingers of your hands go up and down. The set that runs along the inside of your
forearm, when contracted, pull your fingers down onto the keys. These
muscles are tight when you make a fist (feel for yourself.)

The set of forearm muscles on the back of your forearm lift the fingers up again, and are called into play when you open your fist. Find these muscles at work with your left hand feeling your forearm.

Discover how one set relaxes when the other set tenses.

Learn how to balance both sets of muscles so that NEITHER set is being over used or too much demand placed on them.

If you have the fingers too curved on the flute's keys, you may be over-using the muscles on the back of your forearm to do all the work.
Same effect if your wrist is cocked back at all.

Or the opposite:
If your fingers are too flat in their approach to the keys (insufficient curve to the finger knuckles) you are likely only using the muslces on the inside of the forearm.

See if you can find a position that is half-curved, half-flat, in order to balance the workload of the muscles.

Note: Any dissociation of the hand from the arm will cause overuse of
the hand tendons.
Any cocking back or over bending of the wrist (hand and arm no longer in a long flowing line) can cause dissociation of the forearm muscles from the hand tendons.

They must be free to elongate and contract right from the fingers all the way to the elbow.

Much can be gained from incorperating the torso, shoulder and upper
arm into the health and function of the hand and forearm so that the whole body is distributing the small efforts in a balanced way.

See books by Abby Whiteside on balancing the torso and allowing it to direct the arms.

-------------------end suggestions

Hope these ideas help.
Also, definitely bring this topic of right arm pain to the notice of your teacher who can SEE what muscles you may be over-using and what right thumb positions would best suit your particular hand (and can also check your flute for leaks.)

Most teachers don't mess with the way that you're holding the flute in the first few lessons UNLESS you have a complaint about pain.
Never play with pain.
At the very least, drive yourself to succeed LESS, and relax more
during warmups and longtones, stopping at the slightest sense of pain or constriction.

My own recovery from hand & arm pain

To give an overview of what I went through as a hand and arm pain sufferer, and to give fellow-sufferers HOPE :>) I'll briefly outline the steps I took to overcome a left arm problem.

The problem started in fourth year University, right after about six months of intensive "technique" practice, having received a third year recital adjudictation that read: "You move so much on stage that you make the adjudicators feel seasick."

This comment embarrassed me, and made me feel unprofessional. So I undertook to stay absolutely as still as a rock when I played the flute. I locked my arms into position and played for hours. I also wanted to prove that I could play as technically proficiently as some of the better flute players who were younger than I was at the time. I started practicing without breaks, without stretching, and constantly willing my muscles, arms and head to STAY STILL, while executing, over and over again, very difficult techique books such as Marcel Moyse Daily Exercises and Taffanel & Gaubert in the upper octave.

Problem number #1: I did not know that the first step toward solving any ache or pain is to have your flute fixed for pad leaks. I now know that any time hand or arm pain is present there are usually minute leaks in several of the keys that that hand operates. If you have any question about the sealing of your pads, or any pain whatsoever, make sure that you look into pad leaks immediately. Use the best flute tech you can find. Lesser flute repair people often do not find the leaks that an advanced player senses when you clutch the keys too hard.

Towards the end of the year I had a sudden pain in my left scapula, right before my graduation recital. The pain was so severe that I had to play the flute with my left elbow resting on a table top or chair back. I played the recital, received an excellent mark, and then took three days off playing, because the pain was so serious, I absolutely could not play the flute.

Three days turned into three months of not playing. Every time I tried to play the pain in the left scapula would come back in force.

Three months turned into six years. I gave up flute (burn-out) and travelled, worked as a waitress (only later to realize that this overdeveloped and strained my left arm in particular from carrying heavy trays with the left arm), and eventually began a second University degree in another subject. Picking up my flute and playing immediately brought back the pain within ten minutes or so.

I eventually found a deep-tissue massage specialist who worked on musicians. They explained to me that the knot in my left scapula area was so tight and calcified that they could spend hours on it. I undertook eight sessions where the massage person worked on the entire left shoulder area. A year later I found a ROLFING practitioner who made some great changes to my overall tension level through several very deep ROLFING sessions.

Afterward, I felt about 70% relief from the on-going pain and was finally able to play flute again.

I also had four sessions of Alexander technique which showed to me how I had been holding myself in a stress posture. I gradually began to become aware of my habitual posture, and tendency to crunch my neck and shoulders together as a stress reaction.

I began my daily practicing again, but only in very short bursts, and without allowing myself to "drill" technique.

Problem number #2: Repetitive strain injuries can die down and seem to get better, that is until another big work period begins, then the pain seems to come back. The real answer is to completely over-haul the way you use your body and learn its signals. Alexander Technique, Rolfing, Body-Mapping and other modern therapies (deep tissue massage; myo-fascial release therapy etc.) may help you. Try them out. You have much to learn and nothing to lose.

Once I was feeling better, I investigated some alternatives to the way I was holding the flute to allow myself to practice for longer periods of time without fatigue.

I read a great deal, and studied videos of professional flutists.

I was shocked to see a closeup of Jeanne Baxtresser playing with LH key extensions on TV on "Live from Lincoln Center". I had no idea it was acceptable to modify the flute itself. What a great idea!! So, after consulting with John Lunn about adding home-made extensions to the LH keys, I added key extensions to the left hand keys on my flute. (PDF)

This made such an incredible difference to my comfort level, and speed to the operating of the LH keys, that I was able to play technical work again. This gave me great hope, and I auditioned for various concerto competitions, joined an amateur orchestra, and began teaching the flute for a living. By being careful of not over-practicing, and by taking frequent breaks, I was able to keep the left shoulder pain at bay.

Problem number #3: I owned and played an in-line G flute with open-holes. I did not realize until I saw Jeanne Baxtresser on a Live from Lincoln Center broadcast, with her left hand key extensions, that it was possible to take the strain out of the left hand by changing the angle of the keys. I now recommend off-set G for most young players.

I also changed my flute's line-up to modified Rockstro, and this made a good deal of difference to the tension in my arms. To read more about this, click here.

By this time I only had occasional problems with the left arm and only when I over-did it. I was teaching flute for a living, and playing in an amateur orchestra, and doing solo concerts from time to time. Everything seemed to be under control with the arm until I was asked to become principal flute in a professional orchestra, and over the next few years the conductor started singling me out and making me play challenging passages over and over again. I also started working with a chamber musician who's idea of rehearsing was to "drill" passages over and over again.

As a result, during the most tense season, about six years later, a new pain started in my left forearm which was unbearable. Our orchestra was preparing "The Firebird" by Stravinsky, and I was really worried about the Bird mvmt. I started drilling it over and over again, convinced that the conductor was "on my case" and would probably fire me if I did not play it perfectly.

What I didn't know at that time is that I was externalizing my own fear of failure and literally "steeling myself" in order to play under very strict demands. This was not unlike the original damage done when I took the adjudicator's remarks to heart, back in University, when they said that my swaying and dipping while playing made them sea-sick. I was trying to control my body use by mind-over-matter without understanding what kind of damage that kind of civil-war can do to the body itself.

By practicing with an internal critic on my shoulder (so to speak), I practiced very tensely and with a relentless demand for perfection. All of a sudden my left forearm, elbow and wrist then flared up so badly I had constant pain in new places all up and down the left arm, wrist and hand. I then went, in desperation, to my family doctor and asked what could be done. They referred me to a hand and arm surgeon (who did nothing but tell me it wasn't a surgical case).My doctor put me on anti-inflamatories for ten days, which did nothing. I ordered a "Swan Neck" headjoint from Flutelab in the Netherlands, and began to panic about losing my job. This phase lasted a very uncomfortable 15 months or so, with intermittant pain all the time, even when not playing flute. I had to review all that I had learned from various sources about correct body use (relaxing unecessary tension) and constantly remind myself to rest the left arm.

Problem number #4: Although I had found the problem's source, I still couldn't always stop myself from "drill practicing" when I was worried about an upcoming performance. This is the kind of practice where you play a technically demanding passage over and over and over again, trying to prove that you can play it many times over perfectly and at full tempo. Mental attitude has to change for the 'healthy' as well, when you're trying to work with tension and repetitive "over-trying".

Now the method that I learned about not "drilling" when practicing was manifold and full of curious new ways to practice. I derived many of these methods from reading the books of great flute teachers.

You can see my reading list here.

I have included these ideas in my upcoming flute book, as there are too many (needing musical examples) to explain in a single article, however, many of them can be found here, in the articles on this page: go back to top I also very highly recommend the book "The Inner Game of Tennis" by Timothy Gallwey in order to get a quick overview of the new philosophies of sports and arts development.

Althought I knew now to look for 'deep tissue massage' and Rolfing therapy for help, I still couldn't clearly locate the source of the pain in the left arm, although the original injury was never apparent again (scapula knots.)

At this point I contacted another Rolfing praciticioner in desperation, as ROLFING had helped before, and they were able to find the source of the problem: it was in the thoracic region between the neck and shoulder, on the front area of the shoulder well above the armpit. The Rolfer literally had to break apart bands of muscle tightness in all sorts of areas of the body in order to un-twist my posture. The flute stance (I'd been playing since the age of 11 without ever having help with posture and arm position) had caused my entire body to be twisted to the left and the neck and left shoulder were almost permanently twisted due to muscles calcifying in this position.

After 8 Rolfing sessions (and $1000 in cost for the sessions) I was completely pain free for three years. I know it sounds expensive, but it was the only therapy that truly released all the various tension patterns I'd come to live with.

I also found some very helpful therapy from a Myo-fascial Release practitioner in about 3 visits for deep tissue massage on the left, front thoracic and shoulder area which broke the pattern of clutching the left arm in at the shoulder. This finally focused the problems all into one single source; the clutching of the left arm while tilting the head to the right.

Problem number #5: Although I was in almost constant pain, it took many years to finally locate the source of the problems with the left shoulder, thoracic compression, and general tightness that was exacerbated by the tension of the neck. The shoulder/collar bone area is a tight area of muslces, with narrow passages where accumulated tension can be so severe that blood and nerve lines to the left arm can be impinged. Moral: If your arm or wrist is in pain, look higher up the arm; look at the back, your stance, your hips, look for other related areas that may be the REAL problem.

Over time I ordered and read many books, the most helpful being "Body Mapping for Flutists" by Lea Pearson, and "The Physical Flute" by Fiona Wilkinson. I gradually learned how to warmup (30 min.) before practicing, so that my entire posture, arm and hand position was released, easy and flexible, rather than tense, contorted and gripping.

I learned to practice while constantly relaxing different parts of my body until I found a balance between all the variables. I re-body-mapped my left shoulder area, and accomodated my tendency to lift my left elbow too high, which triggered the beginnings of pain in the left arm.

I had my flute fully checked for leaks, and repaired several times over the course of the next couple of years, and discovered that by changing to a different brand of flute, with lighter key action, and lighter keys (plated instead of solid silver) that the problems were less acute. I kept the wooden LH extensions, and added a very useful right thumb "roll-bar" or "Thumbalina" which is glued like a tiny thumb-shelf to the flute under the F key. This made a tremendous difference to the agility and speed with which I could play.

From this point on, I had been suffering on and off since the age of 24, and was now in my early forties. It turned out that every time I had pain in my left hand, wrist, forearm or elbow, that the problem was the tightness in the left front shoulder area where the flute pulled my left arm across the chest. I began experimenting with releasing this area, and "floating it". To read about these ideas, go back to top and choose an article.

I also realized that the pains came ALWAYS when there was exterior pressure to "be pefect" and "not sway" and "play steadily with fast fast fingers" and "be the best".

Realizing that the demands I placed on myself were the true cause of tension took nearly 20 years. HA! :>) Too soon old, too late smart. Philosophy develops and eventually helps. :>)

Moral of the story: Build up your self-esteem and learn to use the body naturally, and in accordance with your real needs as a musician. Books that helped: "Effortless Mastery" by Kenny Werner (fun meditation Cd with NY accent) and "The Performer Prepares" by Robert Caldwell. "The Artist's Way" by Julia Cameron can also cause major breakthroughs in philosophy.

On the physical side of things:

The Swan Neck (bent flute headjoint) arrived, and helped immeasureably in being able to sense what a relaxed left shoulder felt like, and I learned several mental tricks to keeping my left shoulder down in the socket and relaxed, after using the Swan Neck. However, I couldn't make it sound as fine as my straight headjoint, and so would only use it when the problems in the left arm were severe, which from time to time they were.

The final thing I learned, and I am now pain-free, is that you must also look for other areas in which you use excessive or "static" tension when using your wrists and hands when NOT playing the flute.

Occasionally I would get nervous when I felt a tight left wrist, and pains in the back of the hand. I would then discover that the pain wasn't related to flute playing, but to resting my left wrist, cocked back, on the computer keyboard for hours on end. I'd never noticed this problem, and had to become completely aware of it, to stop from agravating the left wrist.

Problem number #6: Although I had found the problem's source, it took me ages to realize that I also damage my left wrist and forearm/hand when I use the computer. Look for other areas in your life where you strain the same arm that you strain when you play the flute.

I'm happy to say that between re-designing my flute's ergonomics, reading a great deal of literature about body use, changing my practice habits, and learning to balance my two hands/arms, and neck when playing, and tempering my philosophy to be more humanistic, that I am now pain free as of August 2005. I can now practice or play up to 6 hours a day without any problems.

I hope you are able to follow a similar path to recovery, and catch your problems, and solve them, before they become constant, or constantly return as mine did.

Continue on to read more minute details about each of these ideas through the articles on this page. go back to top

Good luck!! Jen Cluff

Jen Cluff ~ Flute Pain Cures

Canadian Flutist and Teacher