After the injury: how to return to playing once treatment is done

Three musicians, none of whom had been helped by rest.

A violinist based overseas had been struggling with a chronic shoulder and neck injury. One week before an international competition, the condition worsened to the point where the arm could no longer be raised. After an unsatisfactory result, the musician booked a flight back to Taiwan immediately.

A conservatory viola student had taken a one-year leave of absence because of severe shoulder pain. Despite a full year of rest and treatment, nothing had improved.

A conservatory cello student had been in a serious traffic accident and could no longer play for more than ten minutes at a time. Numerous treatments had failed, and the cellist had been told that returning to the instrument might never be possible.

Each of them was worked up here with diagnostic ultrasound, postural and biomechanical correction, and regenerative treatment directed at the injured fascia, ligaments, tendons, muscles and nerves, with surface electromyography training where it was appropriate. After one to three months, their pain and physical limitations had improved substantially.

But reducing pain is only the beginning. The next question is the harder one: how does a musician safely return to peak performance, and keep moving forward?

I have written this for every courageous musician who has finished treatment and is preparing to go back to the stage — to step into the spotlight again and feel its warmth. Let us take it one part at a time.

Posture

After an injury, your posture needs to become better than it was before, not merely return to what it was. That sounds unfair, and there is a reason for it: in many cases the injury happened precisely because the previous posture and physical capacity could no longer meet the demands of more difficult repertoire. Going back to exactly what you had is going back to the conditions that produced the problem.

So the postural adjustments and rehabilitation exercises recommended during your clinic visits need to be practised consistently, not occasionally. If you are unsure whether your current posture or technique is appropriate, you are welcome to email me every couple of months for review and confirmation.

The instrument

How comfortable and responsive an instrument feels naturally affects how easily it can be played. Coming back after an injury, it is worth remembering something that will feel wrong at first: posture matters more than tone quality in the early stage. Establish the correct posture, and the sound will follow. Chase the sound first and you will rebuild the compensation that injured you.

For left-hand string pressing, begin with the lightest pressure you can manage. It is genuinely acceptable if the string is not fully stopped at first. The priority is the correct hand shape; pressure increases gradually as control returns.

Every part of the setup should be adjusted as carefully as possible — the shoulder rest and chin rest for violin and viola, the endpin for cello, the instrument and chair height for double bass, support devices for wind instruments, bench height for pianists, and the placement of drums and percussion equipment.

For string players, one simple way to help the fingers relearn a relaxed approach to stopping the strings is to move to lower-tension strings. For cello, the Larsen Magnacore Arioso set may be useful for experiencing how little force is really needed. I have tried this set recently: the characteristics are a softer response and a relatively warm, sweet tone, and it may suit smaller halls, chamber music, and even orchestral playing. Comparable lower-tension options exist for the other string instruments.

For the bow arm, it is worth borrowing several bows from friends or trying options at a violin shop. In general, a bow that is too stiff or too heavy increases the risk of injury. However beautiful the sound, it is not worth using a bow that places excessive strain on the body.

Practice strategy

Do you remember which piece, which passage, or which kind of practice first triggered your injury? Identifying those key problem areas is an important first step. You can then work through them one at a time — but never force your way through pain.

Successful rehabilitation requires thoughtful, efficient practice: the least effort necessary, difficult passages approached intelligently, and gradual progression. After treatment, practice time should increase according to a structured plan rather than according to how you feel on a given morning.

The schedule below is based on a musician who had been unable to play for a year because of a persistent injury before coming to the clinic, and who used this progression to resume practising after treatment. Every timeline is different, but the principle underneath it does not change:

Increase the frequency of practice sessions before you increase the duration of each session.

At the beginning, follow a "little and often" approach. Three short sessions spread across the morning, afternoon and evening are better than one long session completed in a single sitting.

It is important to understand that Day 1 is different for every musician. Some begin as early as two days after treatment; others need to wait up to a month. The starting point varies too — if you can already play comfortably for an hour, the progression may begin from that one-hour baseline rather than from five minutes. At follow-up I give individual guidance based on your condition, your recovery and your performance demands.

Warm up before playing — do not stretch

Before practising, what the body needs is a proper warm-up, not static stretching. Stretching immediately before playing may temporarily reduce muscular responsiveness, speed and performance capacity, and therefore increases the risk of injury. A dynamic warm-up is more appropriate before practice or performance.

Stretching is better done after playing, where it helps release muscles that have been held contracted or active throughout the session.

Lifestyle, nutrition and emotional well-being

Healthy rest and sleep habits are one of the most important foundations of physical recovery. After regenerative treatment, injured tissue needs sufficient nutrients to repair and rebuild: adequate protein matters, along with vitamins B and C, particularly during the first three months after injection.

Emotional well-being is part of recovery too, not an optional extra. Reading about mindfulness or meditation may support both physical and psychological health. It may also help to reflect on what this injury has taught you, and how the experience can contribute to your growth as a musician and as a person.

Fascia, ligaments, muscles and nerves

After treatment, fascia, ligaments and muscles generally need around six weeks to reach a more stable stage of recovery. During that period you should still avoid overly intensive practice, heavy lifting, and other activities that place excessive stress on the treated tissues.

Exercises to restore muscular balance can be introduced gradually after about six weeks. This does not mean conventional heavy resistance training. It means the specific exercises taught during your clinic visit, tailored to the physical and biomechanical demands of your own instrument.

For those who already have numbness or other symptoms related to nerve injury, recovery takes longer. In more severe cases, nerve healing occurs gradually over several months.

In the music of life, uncertainty is the only constant.

Written by Dr. Daniel Su at A Tempo Regeneration Center for Musicians, Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan. This article is general and educational, and is not a substitute for individual examination and advice. All rights reserved.