ST. PAUL, Minn. -- Playing hurt was just part of the job for musicians for decades -- something to endure in silence, hoping it would go away with more practice.\n"No pain, no gain" was the prevailing attitude. Musicians feared they would be blamed or considered weak if they admitted feeling pain and took time off to heal. Their careers could be damaged.\nBut that attitude is changing, albeit slowly, partly due to three decades of work by a petite cellist whose voice is resonating among musicians around the country.\nJanet Horvath, associate principal cellist with the Minnesota Orchestra since 1980, speaks from experience when she presents seminars to help musicians prevent and treat injuries caused by overuse of muscles, harmful playing techniques and instruments that don't fit their bodies.\nHorvath, who at 5 feet stands about as tall as her cello, was a 22-year-old student at the IU School of Music in 1974, thrilled to have been accepted to study under renowned cellist Janos Starker. She was determined to be the best Starker student ever.\nSo she practiced. And practiced. And practiced. Eventually, her left arm began to hurt. But she kept quiet, thinking the pain would disappear as she got in better shape as a cellist.\nInstead, it got worse.\n"My pain became so acute that I couldn't use a knife and fork, or turn a doorknob, wash my hair or hold a telephone. I had let it go too long," Horvath recounts in her book, "Playing (less) Hurt: An Injury Prevention Guide for Musicians."\nStarker was on tour at the time and Horvath didn't touch her cello for three months, resting her muscles. When Starker returned, she worked up the courage to tell him, and they worked together to adjust her posture and playing technique to eliminate tension and focus on ease of playing.\nAfter nine months, Horvath was cured and on the path to becoming an advocate for injury prevention. As she encountered more and more colleagues in pain, she began researching pain issues.\nFellow musicians with muscle and tendon disorders, nerve problems, hearing loss, and lip, jaw and teeth problems started asking Horvath for suggestions. Her work with musicians, physicians, therapists, orchestra managers, college teachers and insurance carriers led to a national conference called "Playing Hurt" at the University of Minnesota in 1987.
Now, 16 years later, some musicians take the pressure off by using splints to support their limbs and special supports to hold up heavy instruments. They are experimenting with special chairs and modified instruments -- smaller piano keyboards for people with small hands, for example, and a viola that is stretched diagonally to help relieve a musician's elbow pain. Some musicians use plexiglass shields to protect their hearing.\nPerforming arts medical clinics have sprung up, and there's a textbook for medical students who might want to specialize in the field.\nThe interest also is reflected in the success of Horvath's book. Self-published in 2002, a year later she had sold 3,000 copies. The book was in its third printing, and it was carried by Barnes & Noble, large mail order music stores and bricks-and-mortar music stores around the country.\n"It's a tremendously changed area, although we're still, I think, quite behind sports medicine," Horvath said. "But we're getting there, and it's partly due to the rampant nature of overuse injuries, the repetitive strain injuries that are occurring in the workplace due to the computer."\nIn May, the Indianapolis Symphony became the first major orchestra in the country to require its musicians to attend a two-day pain prevention workshop.\nAll musicians have injury issues, Horvath says. For cellists, it's often lower back pain "because we sit on two inches of chair and we don't have the advantage of any kind of back support," she said.\nThere's also arm fatigue. Horvath analyzed a two-minute movement of the aria "Why Do the Nations" from Handel's "Messiah" and found her right arm moves back and forth 740 times during the 96-bar movement. "Try brushing your teeth with 740 strokes," she said.\nAlthough Horvath says medical problems are most prominent among string players, clarinetists and oboe players can have thumb problems because the weight of the instrument rests on one thumb, drummers often have shoulder problems and trumpet players develop shoulder pain similar to painters or others who have to keep their arms at shoulder level for long periods.\nDr. Jennine Speier, a Twin Cities specialist in physical medicine rehabilitation who has been treating musician injuries since the mid-1980s and has worked closely with Horvath, said musicians are becoming more willing to talk about their injuries and seek treatment. And more doctors are becoming knowledgeable about the types of problems musicians experience and what specialists are best trained to evaluate and treat them, she said.\nIn her own case, Horvath says, her biggest mistake as a student was waiting a few weeks before telling anyone she was hurting.\n"These injuries really can be nipped in the bud," she said. "They can be very minor if you pay attention to what your body is trying to tell you right away"
