Improving peak performance is on the mind of most flutists. Many attempts to improve skills are done on a daily basis. Sometimes the attempts are successful, other times teasingly slow or even impossible. While struggling to improve, questions arise such as: “What makes some flute players successful, while others, with hours and hours of practice, are not?” “Why do some flute players develop pain symptoms, and others not?” “What is preventing a flute player to progress to the next level?”

The answer is abnormal tension. Abnormal tension is the major barrier to playing the flute perfectly and pain-free. It is clear that failure to learn a new piece of music is consistently a function of the inability of muscles to follow a specific sequence of motion. The challenge now is to figure out why the muscles are not able to do the job.

The invention and rapid development of the technology of Surface Electromyography (SEMG) give us answers by supplying detailed insight on how muscles operate.

Figure 1. Muscle activity is displayed on a screen during flute playing. The flute player can correct muscle activity immediately

It provides not only data on muscle contraction, but also the ratios of contraction that work toward the same goal. This data type is the key for understanding how efficient muscles work together to accomplish flawless movement mechanics for playing a musical instrument. If for any reason, playing/movement efficiency becomes less than optimal, a muscle imbalance may develop. Even though the goal of the movement will be reached, the strain to the muscle and other structures become more intense. This abnormal muscle tension is what manifests into injury.

If pain, tension, or tightness is blocking movements, many musicians will try a variety of strategies to improve. These may include physical therapy, occupational therapy, acupuncture, massage therapy, chiropractic care, Alexander Technique, Feldenkreis Method, body mapping - the list goes on and on, every discipline claiming to have the answer for these problems. Often, therapies are successful in resolving pain and tension. Other times, no matter how hard or how long one persists, the problems will not resolve (or not completely resolve). Many musicians struggle too long with one or more clinicians before finding a solution or give up playing. Usually it is not the therapy that is lacking, but the failure of the correct muscle to fire when needed. Chiropractors align the spine, physical therapists strengthen muscle, and acupuncturists block the pain. However, for long-term recovery patients should ask, “Do I know how to sustain correct movement to avoid abnormal tension so my pain will not reoccur?”

SEMG may be the solution in these situations. SEMG provides immediate data that allows musicians an awareness of how to play efficiently without pain and tension. If an instructor of Alexander Technique, Feldenkreis Method, or body mapping asks the patient to do a specific movement, SEMG data gives immediate feedback, so the patient can focus on using the correct muscle action to accomplish the task. It is extremely helpful not only for the musician, but also for the clinician.

SEMG (often called Biofeedback) is a tool to assess the muscle function in detail.

Figure 2. SEMG assessment of a flutist for muscle tension around the neck and shoulder. When tension is high the colored area on the screen becomes larger.

SEMG measures an electrical charge released with every muscle contraction, and is non-invasive and painless. Faulty movement mechanics can be detected and corrected quickly preventing overuse and strain. Even if the muscle contractions are slightly high, problems may be develop over time. SEMG will display the smallest muscle contraction on a computer screen. Most exciting about SEMG is its ability to provide real time feedback - muscle tension can be measured during exercises and during flute playing. The musician is able to see the incorrect muscle activity and correct it at the same time. In this way, the patient becomes his own clinician and instructor, and is empowered to make changes and to understand how to sustain them.

SEMG is used for many applications, such as overuse injuries, poor awareness of muscle tension (e.g. headaches), and performance anxiety. Faulty movement mechanics are often caused by weakness of one or two muscles. The weaker muscles, which are currently not conditioned to sustain their task, can be isolated, strengthened and trained to restore normal movement patterns. There are multiple conditions that may develop these muscle imbalances or abnormal muscle tension.

The following conditions may be a cause of pain or inefficient movements.

1. Poor posture and flute handling

2. Poor general condition

3. Poor practice habits

4. Weakness

5. Poor breathing

6. Stress

Nearly everyone is familiar with these conditions and will try not to fall in these traps. Unfortunately, a large number of musicians do not take these conditions seriously. They slowly fall into a trap or bad habit because problems and pain do not present themselves right away. Soon the musician will be saddled with poor movement patterns, gradually limiting his abilities. Then suddenly, when performance or practice pressure is on, overuse injury appears. Due to the abnormal muscle function, healing from these injuries becomes very difficult. The reason is twofold - weakness of muscles and abnormal tension elsewhere to compensate for the weakness. In order to fix the problem there must be resolution of abnormal muscle tension and weakness.

1. Posture and flute handling

• Neck/flute position

• Shoulder with elevated tension

• Elbow too high

• Wrist too much extended

Example: After playing the flute for two hours you feel some fatigue and note that you have lowered the angle of the flute. You remember not to play in this position, due to bad position of your head and neck, so you forcefully pick up the flute to its normal position.

Figure 3. Correcting the flute position by raising the shoulder results in increased tension of the neck muscles, displayed on the screen with the graph in blue (third from above).

This time you used a different muscle, because you cannot use the correct muscle easily due to the fatigue level. You continue to play for another hour in the same position, flute straight, but higher (abnormal) tension level. Now you have created an abnormal movement pattern and bad habit. If you continue to play like this, neck pain may occur in the near future.

2. Poor general condition may produce abnormal tension levels

• Early fatigue with postural muscles

• Increased breathing rate

Example: You are busy with work, your kids, and performances in the evenings. You have skipped your general work-out routine for the last several months, you find yourself playing reclined on the couch or slouched in a chair more often. Still needing to read the music, you did not notice that your head is too far forward. You are sustaining this position more in your daily life, increasing the muscle tension of the upper neck. In the next several visits with your primary care physician, you report that the flute playing is fine, but headaches are more and more intolerable. Your primary care physician may mistakenly attribute this to stress or a busy lifestyle.

3. Poor practice habits may produce abnormal tension levels

• Forcefully/repetitively learn a new skill

• Irregular practice schedule

• No warming-up/cooling-down

• Suddenly increase frequency/duration/intensity of practice

Most musicians have experienced tension and/or discomfort, when learning a new piece of music. Despite trying several times to play those difficult sequences, you feel that improvement is necessary. You are getting frustrated. The following attempts are with more force in your hands. You continue to play with slightly higher tension in your forearm. You accidently learned a poor and forceful strategy to play the piece and are developing tendinitis (elbow pain).

4. Isolated weakness

• Poor posture

• Poor habitual motions

• Poor body-mechanics

Prolonged slouching or poor body-mechanics may contribute to disuse of certain muscles. For example, if you are slouching and let your shoulders drop forward, the muscle that holds your shoulder blade backwards in the correct position will develop weakness. With your shoulder forward, it is more efficient to use a different muscle strategy. You have created bad posture, with permanent forward position of your shoulder blades. The next 2-hour recital will be a bigger challenge than it has ever been.

5. Poor breathing may lead to abnormal tension levels

• Upper chest breathing

• Superficial breathing

• Straining

Forced upper chest breathing activates muscles that normally assist with breathing in situations where increased oxygen is required. Those muscles however should not be activated on a consistent basis. If this is the case, abnormal tension develops resulting in strain and abnormal posture of the neck.

6. Stress usually increases tension of the neck and shoulder muscles.

• Stage fright

• Stress related to peers, parents, or instructor pressure

• Stress related to family, work, or financial situation

A stressful situation increases the activity of the autonomic nervous system. (e.g., deer caught in headlights). This basically means that the nervous system becomes more sensitive to all stimuli. It also includes an increase in muscle tension. Stress may affect the ability to play well in front of an audience while pain and tension can interfere with many functional activities.

How to resolve abnormal movement patterns?

• Identify, isolate, and strengthen weak muscles

• Remove abnormal tension

• Integrate new muscle balance in flute playing and all other activities

The most difficult problem in retraining weak muscles is to avoid engaging the stronger muscle with abnormal tension. Activation of the stronger muscle will maintain the muscle imbalance. SEMG provides awareness of all muscles involved.

Figure 4. Exercises are monitored by SEMG to retrain subtle muscle imbalances. The therapist and the musician can observe the muscle activity immediately and correct mistakes if necessary.

Figure 5. Mistakes are difficult to catch by eye, but easily discovered with SEMG. A symmetrical wall push-up demonstrates 3x the muscle tension on the right side (red) compared to the left (blue).

It monitors muscles with real-time feedback for immediate down-training of strong muscles and up-training of weak muscles. It normalizes movement patterns thereby solving the problem, not just temporarily controlling pain. The muscle imbalance or bad habits will be completely removed. This will prevent you from relapses and set you free from obstacles in the way towards more difficult, faster and longer hours of playing flute. It is a challenging task, but the peak of your performance will be at levels previously unknown to you.

Johannes G. (Hans) van Buuren graduated in Physical Therapy in Rotterdam, the Netherlands, in 1986, and moved to the USA in1988, obtaining his Masters in 1991 and Doctorate in Physical Therapy in 2005, both majoring in orthopedics. He received a certificate in Manual Therapy in 1991 and his Orthopedic Clinical Specialist in 1999. Currently employed at Virginia Mason Medical Center, Out-Patient Clinic, Hans manages the Clinic for Performing Artists, where he specializes in evaluation and treatment of musicians. He teaches regularly at the University of Washington in Seattle, WA, and throughout the USA.