Ten myths about pain that musicians are taught to believe

For musicians, pain is often misunderstood as part of the journey. Many performers are taught to endure discomfort, practise harder, and push through until the concert, the audition or the examination is over.

From the perspective of performing arts medicine, persistent pain is not something musicians should simply accept. Pain is a signal. It may reflect problems in posture, technique, motor control, muscle or fascia injury, tendon or ligament injury, overuse patterns, or the way the body interacts with the instrument.

In my clinic in Taiwan, the goal is to help musicians return to playing with less pain, better control, and greater confidence — in a way that is healthy and efficient, and that lasts. What follows are the ten beliefs I hear most often, and what I think is true instead.

Myth 1 — "Pain is inevitable. It is the sacrifice we make for art."

When children first begin learning an instrument, some discomfort may occur. The muscles are not yet conditioned and the body is still learning how to coordinate with the instrument. If the discomfort is mild and temporary, it may be acceptable at that early stage.

But once a musician becomes more familiar with the instrument, persistent pain should not be considered normal. If pain persists, it is time to examine posture, practice habits, technique, and how the body is interacting with the instrument.

Pain is not a necessary part of music-making.

After all, if musicians wish to keep giving themselves to art, they must first protect the body that allows them to perform.

Myth 2 — "My hands are weak, so I should practise more to make them stronger."

Many musicians respond to technical difficulty by using more force. If the chord is hard to reach, they press harder. If the piano keys feel heavy, they practise with even more effort. The belief is that more force will prepare them for performance.

But weakness does not always improve by practising more. The body does not work that way. When one muscle is overused, it can inhibit the function of other muscles and reduce the efficiency of the whole movement system. In other words, a musician may feel weak not because the body lacks strength, but because the wrong muscles are working too hard while other important muscles are not contributing at all.

The key is to identify the overused muscles, release the unnecessary tension, and then strengthen the muscles that are underworking. That is how a compensation pattern is corrected, rather than simply relieved.

This kind of problem is usually evaluated through a combination of clinical examination, dynamic observation while you play, musculoskeletal ultrasound, and movement analysis.

Myth 3 — "Massage, acupuncture, patches, manipulation or painkillers are enough. I can keep going."

Massage, acupuncture, topical patches, ointments, manual adjustment and pain medication may all provide temporary relief, and may reduce muscle tightness or discomfort for a while.

But if the same tightness keeps returning, the deeper issue may not be the muscle at all. Recurrent tightness often happens because an underlying ligament, tendon, fascia or other soft tissue structure has been injured. When the body senses instability, the muscles have to work harder — contracting harder — to protect the area. That creates a cycle of tightness, fatigue and pain that no amount of massage will break.

Temporary relief is useful in early or mild stages. But once symptoms have progressed, masking the problem stops being a strategy. The real cause needs to be identified. In performing arts medicine we look at several factors together:

• Instrument setup — proper setup is fundamental, not cosmetic
• Muscle activation pattern — is there a compensation pattern?
• Joint stability — any sign of hypermobility?
• Fascia, muscle, tendon and ligament condition — scanned with ultrasound, including during playing
• Practice schedule and performance demand — was there a sudden increase in practice volume?

For musicians with more advanced symptoms, professional evaluation is worth arranging. Treatment should not only relieve pain; it should correct the cause underneath it.

Myth 4 — "When I really cannot tolerate the pain, I can just get a steroid injection."

Steroid injections are common because they reduce inflammation quickly, and in some situations they are genuinely helpful.

For musicians, though — especially where the problem involves tendon, ligament, fascia and muscle that are heavily loaded during performance — steroid injection can lead to tissue atrophy, and to tissue that tears more easily once tension increases again.

I tell musicians two things about this.

A steroid injection is like covering your ears while playing out of tune. You may not notice the problem, but the problem is still there.

And second: repeated steroid injections weaken soft tissue. When the effect wears off, the tissue may be more vulnerable than it was before.

Musicians spend years developing refined control, endurance and precision. For that reason, treatment should protect the quality of the soft tissue, not merely silence the pain. Where it is appropriate — particularly for tendon, ligament, fascia and muscle injuries — I use ultrasound-guided regenerative options such as PRP instead. We do not use steroids in this clinic.

Myth 5 — "This concert or audition is everything. I have to push through, no matter what."

There may be more auditions. There may be more concerts. There may be another season, another opportunity, another stage.

But there is only one body.

Pushing through severe pain before an important performance can feel brave. It is also a gamble. Musicians often feel that one concert, one audition or one competition will define everything — but a performing career is usually far longer than it feels in that moment. A short-term decision should not create a long-term injury.

Protecting the body is not giving up on music. It is part of sustaining a musical life.

Myth 6 — "If I cannot play a passage, I should repeat it until I get it."

Repetition is not wrong. But only meaningful repetition genuinely helps.

Slow practice matters, and so does intelligent repetition — different speeds, different fingerings, different bowings, different rhythms, different mental strategies. The goal is not to repeat a movement unconsciously; it is to help the brain reorganise the movement more efficiently.

If a musician repeats an incorrect movement pattern twenty times, it may take many more repetitions to correct it later.

Practice efficiency matters. A good practice method should improve musical ability while reducing unnecessary physical stress. Musicians should not only practise harder — they should practise smarter, with awareness of both the sound and the mechanics producing it.

Myth 7 — "Only fast and loud music causes injury."

Most musicians know that extremely fast or extremely loud passages increase injury risk. They demand greater force, speed, endurance and precision.

What gets overlooked is the opposite: extremely slow and extremely soft playing. Slow, soft passages require prolonged control, sustained tension and very fine motor precision. If the body is not properly warmed up, that kind of playing places significant stress on muscle, tendon and fascia too.

For this reason, a warm-up should not always begin with long tones or with the most delicate playing. It is often safer to start at a moderate tempo and a moderate dynamic. For string players, something like crotchet = 60 with four notes to a bow is a reasonable way to begin.

The goal of a warm-up is not to prove your control immediately. It is to prepare the body, gradually, for what you are about to ask of it.

Myth 8 — "As long as the music sounds good, posture does not matter."

In the clinic I often hear beautiful playing from injured musicians. Then I watch the posture and the movement carefully, and the body turns out to be extremely unbalanced.

The music may sound beautiful. The body may be working far too hard to produce it.

There is no absolute perfection in music; there is always room for refinement. Improving posture is not only about preventing injury — it can also help a musician reach a higher artistic level.

The ideal is not to force the body into a rigid "correct posture". It is to let the body support musical expression in the most ergonomic and efficient way available to that body.

Some musicians tolerate poor posture for years simply because they are young, strong or highly adaptive. That does not mean the posture is safe forever. As performance demands accumulate, the body eventually reaches its limit. A sustainable technique should serve both the sound and the body.

Myth 9 — "I can overcome injury by willpower."

Discipline matters in music. Persistence matters. But pain should not be ignored in the name of willpower.

Modern performing arts medicine offers better ways to analyse why injuries happen: detailed examination, dynamic movement assessment, ultrasound imaging, surface EMG, rehabilitation planning, and regenerative medicine where it is appropriate. Musicians do not need to rely on endurance and guesswork alone.

When better tools exist, it is wiser to return to professional evaluation and structured treatment. The aim is not to make musicians afraid of practice. It is to help them practise and perform with more intelligence, more efficiency, and a longer career.

Myth 10 — "That famous musician plays this way. Why can't I?"

Every musician has a different body.

The strength of the fascia, ligaments, tendons and muscles varies from person to person. Hand size, finger length, arm length, joint mobility, spinal shape, endurance, previous injuries and years of training are all different. A posture or technique that works for one famous musician may be entirely unsuitable for another.

This matters most for students and young professionals. Imitating a great artist's sound, phrasing or musical imagination can be inspiring. Blindly copying their body position can create problems, if your anatomy and physical condition are not theirs.

You are not someone else. You are not your teacher. You are not your favourite soloist. Your playing method must fit your own body.

My goal is to help each musician find a healthier and more individual way to play — not by forcing everyone into the same posture, but by identifying what allows that particular musician to perform with freedom, stability and less pain.

A musician is not an ordinary patient

Musicians' pain often appears only during specific playing movements — at a specific tempo, in a specific register, at a specific posture, dynamic level or technical demand. So the evaluation has to be musician-specific too. In my clinic, assessment may include:

• Clinical diagnosis of the painful area
• Ultrasound evaluation of the injured soft tissues
• Dynamic ultrasound examination during playing-related movements
• Surface EMG analysis of muscle activation patterns
• Posture and instrument-position adjustment
• Movement correction and retraining
• Fascia, tendon, ligament and muscle assessment
• Ultrasound-guided regenerative injection where indicated

For string players, pianists, wind players, percussionists and singers alike, the aim is not simply to treat pain. It is to understand why the pain appears during performance, and to help the musician return to playing with better balance, efficiency and confidence.

Music is demanding. Your body deserves the same level of precision and care that you give to your art.

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.