Navigating the Wilderness of Overuse Injury with the Alexander Technique

An uncertain pathway ahead. Photo by Jonathan Toner

“Consider this spring,” said Catherine Kettrick, my Alexander Technique teacher. She handed me a small metal coil. “What happens when you push on it?” I pushed on the spring and released it, watching it tighten and then return to its natural length. She continued: “The spring is like your spine. When compressed, it is tighter and has less natural movement.” I agreed. Her husband and teaching partner, David Mills, chimed in: “And who is doing the pushing on your spine? You are! But YOU can also stop pushing. And you stop pushing from the top—your head. Let your head move up and your whole spine will follow.” I played with the spring and considered what Catherine and David were saying about my head leading and my whole body following. The strangest sensation came over me. I felt immensely light, like some deep part of me was unwinding in slow motion. I was also completely confused. What was happening? The other students in the room exclaimed, “You just got an inch taller!” At that moment, my path veered in a new and unexpectedly beautiful direction.

Prior to this, I had been powering up the steep incline of the Busy Musician’s Life. After finishing a masters of educational psychology, I began building my Suzuki teaching practice in earnest. During one school year, I went from eight to thirty students. I taught in several locations around Seattle, performed in an orchestra, became the volunteer scheduler for several music festivals, and had a good chamber group. The rapid pace of going, doing, and achieving felt a little tiring, but also fun. This was the way, right?

Unfortunately, I took an unplanned plunge into the valley of overuse injury. When my studio expanded, I got twenty new beginners who spent months learning the repetitive Twinkle Variations. I continued to play through a lot of the lessons as I had when my roster was small, and developed a nagging wrist pain that spread to my neck and upper back. I was dismayed. Ironically, prior to injuring myself, I had spent years re-learning my violin technique and releasing tension from my playing. During college, I devoted hours to improving my technique with open strings, scales, and etudes—with great results.

After college, I took Suzuki teacher training with Cathy Lee, which unlocked even more freedom and precision in my bow arm. When I began teaching, one of my goals was to impart healthy alignment and freedom of movement so my students could express themselves musically. I took great care to ensure that my students were well set up. And yet, there I was, fumbling through a painful and unwanted detour. I hoped it would be a quick setback and that soon all would return to normal.

An Unwanted Valley

My initial route through overuse injury was bewildering and convoluted. After more than ten years of tolerating four or more hours of violin per day, my system began to send pain signals in the form of stiffness, knotted muscles, and a tingling right arm. Stressful hours bent over a laptop planning workshops and music festivals didn’t help. My outdoor interests, competitive road cycling and mountaineering, further strained me. So, I rested, stretched, and iced. I tried adjusting my chinrest and shoulder pad. I re-doubled my efforts to relax my shoulder, neck, and wrist. When that didn’t work, I got a few massages and did my first round of physical therapy, with mediocre results. I had limited time, finances, and knowledge. As the pain became a constant, low-level irritant, I felt that I had failed on multiple levels.

As string teachers, we learn that tension is the enemy. But, we are not always equipped to navigate this with our students, or ourselves. Sadly, many professional musicians experience chronic injury. In a recent Australian study, 84% of professional orchestral players surveyed had experienced injury, and “less than 50% reported that they had completely recovered” (Ackermann, Driscoll, and Kenny 2012). Many choose to play through chronic pain, hide the injuries, or rely on painkillers to cope. Like these musicians, I continued working through my pain. My symptoms weren’t bad enough to completely quit, but they weren’t resolving on their own. What other option did I have?

Thankfully some landmarks emerged from the haze as I ventured to physical therapy, chiropractic care, massage, and then more specialized physical therapy. I learned new terms like “brachial plexus,” “fascia,” and “nerve impingement.” All of this helped somewhat: with medical treatment and rest, the knotted muscles calmed down and I felt better. I learned how to foam roll and do myofascial release at home after work, which provided relief. But, maddeningly, the same pains quickly resumed when I returned to a normal violin workload. Slowly, I began to realize that there would be no return to my previous normal. My life had branched into an unknown direction.

When I am in the mountains, the way is not always clear and route descriptions can be vague. One climbing guidebook author is famous for telling mountaineers to “ascend the obvious gully” when the gully is anything but! If I get a little lost on a hike or climb, I stop, re-read the route description, study the landscape for clues, and then either find my way to the top or turn around and retreat. However, when I injured myself, I entered a confusing landscape for which there was no trail and no route description. After several years, I still felt lost. Many medical providers seemed a little puzzled by my case, so I began to look deeper. An underlying cause emerged: my teeth. Though I had a nice smile, I had a tongue tie and had pushed my teeth open so that only my back right molars met. I learned that this cranial asymmetry caused a lot of torsion, compensation, and confusion in my system, making me much more prone to injury than the average person. (Lucky me!) Much later, I learned that I had a vision issue called convergence insufficiency that placed extra strain on my system. Over the next decade, I formed a team of specialists who recognized my symptoms and knew what to do. Orthodontia, myofunctional therapy, holistic chiropractic care, specialized physical therapy, craniosacral work, and vision therapy have all been, and continue to be, essential. Yet, even in the beginning, I suspected that medical help alone would not solve the issue entirely, due to the patterned nature of my pain. I wondered if there was also something I was *doing *to myself. My Suzuki background gave me the confidence that I could keep learning. I knew that there must be a way, even if it was circuitous and the trail faint.

Finding the Alexander Technique

My experience with recurring injury patterns paralleled that of the founder of the Technique, Frederick Matthias Alexander (1869–1955). He was an Australian actor who was born prematurely and suffered from respiratory issues as a child. As a young actor, he experienced chronic hoarseness and even lost his voice during an important performance. Unfortunately for him (but fortunately for us, as you’ll see in a moment!), medical help and rest didn’t address his issue. F.M. wondered if his problems were due to something he was doing while he was performing.

Alexander chronicled his discovery in “Evolution of a Technique,” the first chapter of his book The Use of the Self, published in 1932 and again in 1941. First, he stood in front of a mirror and observed himself. He noticed that before he began to recite, he tended to “pull back the head, depress the larynx, and suck in breath through the mouth in such a way as to produce a gasping sound” (Alexander 2001, 92). Upon closer inspection, he saw that he did the same things on a smaller scale during ordinary speaking. When he tightened his neck, his whole stature compressed. When he allowed his head to move forward and up in relation to the top of his spine, his whole body lengthened and widened. Like magic, the strain on his vocal cords went away and his speaking voice returned better than before. Thus F.M. Alexander discovered this important fact: our head-spine relationship determines our overall quality of movement, or “use,” which affects our performance.

The lesson of the spring showed me Alexander’s discovery in a nutshell. I will make an important note about my experience here: although Alexander Technique teachers frequently use their hands as part of the teaching process, Catherine, my wise teacher, did not use her hands at all when she gave me the spring. First, she showed me how much power I had to change myself, even when I was a total beginner. Catherine, David, and my third teacher, Cathy Madden, did go on to use their hands often and skillfully as part of the teaching process, but it was always with the understanding that I was the one asking my system to coordinate. My teachers were using their hands, as Cathy Madden puts it, to follow me as I said yes to the new idea (Madden 2018, 85). They were my knowledgeable guides, helping me forge my own route through the unknown.

{media:50737:lgg:r:An image of young fern fronds, representing the unfurling process made possible by the Alexander Technique. Photo by Lisa Toner.}

A New Pathway

I remember driving home from my first Alexander Technique lesson feeling elated about the unexpected pathways that had just opened up to me. Finally, I had discovered an actual solution to tension! This was a holistic, non-invasive way to take pressure off my system, giving hope for greater ease in my playing. I immersed myself in the Alexander Technique, going to class weekly for many years and enrolling in the teacher training program. During this time, I also began to connect with the more specialized medical care I needed. In my early lessons, I learned that the head-spine relationship governs our overall quality of movement. Next, Catherine and David taught me that we move as a whole. Trying to release tension from individual body parts is a limiting approach and will never work completely; it just moves the problem elsewhere. This is why asking someone to relax their shoulder usually has limited results. In contrast, releasing pressure from the top of one’s spine allows the whole system to decompress, and everything reorganizes more freely.

Where, you may ask, is the top of one’s spine? People point to a variety of places when I ask them this during introductory classes; they typically guess too low. Try this: place your fingers in your ear holes and nod your head lightly. You are pointing to the atlanto-occipital (AO) joint, the joint between the base of your skull and the top vertebra of your neck. This joint primarily nods; the larger turning and twisting motions of the neck come from further down. What you just did is called Body Mapping, founded by Barbara and Bill Conoble, both Alexander Technique teachers. They noticed that when their students understood the anatomical truth of their design, they learned more rapidly. Barbara’s book, What Every Musician Needs to Know About the Body, has beautiful illustrations and is worth keeping on your music stand. By integrating Body Mapping into my study, I became a much better physical therapy patient, musician, and teacher. I use Body Mapping extensively in my teaching. I always have anatomy books, models, and drawings available in my studio whether I am teaching the violin or the Alexander Technique.

When we interfere with free, easy movement between the head and spine, the rest of our system compresses, just like pushing down on the spring. Try it: scrunch your neck and pretend to play your instrument, or walk around. What do you notice? Now, unscrunch and observe the change in the quality of your movement. It is fascinating to observe how our system responds as a whole. If you are compressed, your arms will never move as freely as they could, and trying to relax your arm will not solve the problem. But why do we interfere, tighten, or go out of coordination? It varies. Stress, well-intended but inaccurate instructions we heard from our teachers, imitation, structural issues, and more can cause us to tighten. And, we are well-designed to learn and maintain patterns. Habitual tension can be difficult or impossible to get rid of, especially if you are trying to relax individual body parts. Jennifer Johnson, author of What Every Violinist Needs to Know About the Body, calls this the “relaxation disease,” as trying to relax often leads to a whole-system collapse.

Neuroscience is providing exciting insights about how patterns and habits are formed. The skills we cultivate through practice and repetition shape our brain. Many of you have likely read The Talent Code, in which Daniel Coyle describes deep practice as an optimal state in which one enters “that productive, uncomfortable terrain located just beyond our current abilities, where our reach exceeds our grasp” (Coyle 2009, 92). During these focused repetitions, neurological pathways become more insulated by myelin, a fatty white substance that speeds up the firing between nerves. Well-worn, habitual brain grooves are comfortable, useful, and reliable, and we need them to tie our shoes, drive a car, or play a musical instrument.

Patterns can come from more surprising sources, too. Here’s a fun one: we have something called mirror neurons, which activate both when we observe someone doing a task and when we do the task ourselves. This is why imitation is such a powerful learning tool. Think of how some teachers’ students have a certain “look,” for better or for worse, or how some families all stand with the same frumpy crossed-arm posture. This underscores how our overall use, or how we move, can come from surprising, unconscious sources. But what if a pathway needs updating? Can you become neuroplastic and make new pathways, even if you are an adult?

Creating New Patterns

As I studied F.M. Alexander’s writings and started to examine my own pathways more closely, I felt myself relating to his quest. He had discovered that when his head moved easily on top of his spine, the rest of his system worked better. The crux of his experiment came when he tried to apply his new use to his desired activity: performing. He found that the pull to familiarity and ingrained patterns was too strong: just at the moment when he went to recite, he instantly reverted to his old familiar way, despite his best intentions. He continued experimenting and eventually made his breakthrough discovery: if he paused before speaking, inhibited the desire to speak, and then directed his “head to go forward and up and his back to lengthen and widen,” rather than trying to go straight to the activity, he had space to make a fresh choice about whether to proceed (Alexander 2001, 92). If he chose to proceed, he could continue projecting the directions for the new use while carrying out his activity. He had essentially hacked his neural pathways, tricking himself into overriding the old pattern so he could use the new one in his activity!

I read Alexander’s original work in detail, but his writing can feel archaic and is also full of “no” language. I appreciated that my teachers used modernized language to explain the process. I have come to use Cathy Madden’s wording for the Alexander Technique process, something she calls “calling the whole self via head-spine” (Madden, 2014):

I ask to coordinate,
so that my head can move,
so that all of me can follow,
so that I can do what I’m doing.

Each part of the process leads to the next. The “ask” to coordinate is the moment when we deliberately choose to call ourselves into a more optimal state. The movement between the head and spine is not a deliberate nod or movement, but refers to the free, tiny passive movements that should be happening all the time. When we free the head-spine relationship, our whole self can follow: spine, limbs, emotions, and thoughts. This enables us to do whatever we are doing with greater ease.

I learned the basics of this process after about ten lessons, but found that it took months and years for my understanding to deepen. Often, I discovered things that were completely unrelated to my overuse injury; the Alexander Technique is about much more than support for pain. As I learned to release the pressure on my system and carry the new coordination into my activity, I had a variety of reactions. Usually, it was fun! All of the violin techniques I knew worked better than before. When performing or presenting, my ideas were more clear. Often I felt lighter. However, sometimes I felt confused, frustrated, or even sad about letting go of a well-used pattern. For example, I tended to tighten a little when I wanted to understand something. When I learned that I could be deeply curious while remaining in coordination, it felt strange. Also, I recalled my diligent efforts to follow instructions given by various violin teachers who saw something they wanted to fix. Lines like “just relax,” “keep your shoulder down,” or “play from your back” had frustrated me at the time, and had actually caused injurious patterns in my movements that took patience to sort out. The Alexander Technique served as a useful translation service. Each time that I made another tiny step of progress, I thought to myself, “THAT is what they actually meant!”

Gradually, these tiny steps led me out of the valley of overuse injury. There is much to celebrate, but it’s definitely not the straightforward success story I was initially hoping for. New, rewarding pathways have emerged, like becoming an Alexander Technique teacher myself. When I integrated these principles into my violin teaching I began to see my students more clearly. I find it easier and more joyful to fulfill my mission as a Suzuki teacher, but I am much more aware of the potential challenges of teaching a repetitive, asymmetrical activity to someone. The pain I experienced while playing the violin is gone, but I am still careful with how much I play. I have updated many unhelpful movement patterns, got nearly two inches taller, and am able to push myself in some athletic pursuits. Yet, there are still puzzles to solve, and caring for my alignment will likely be a lifelong practice. I sold my road bike, am in year seven of orthodontia, and still spend a lot of time going to appointments. And, I don’t think I’ll ever summit the peak of the Busy Musician’s Life, if there is such a thing. I have, however, found many other rich and rewarding things along the way. The Alexander Technique has been my compass for navigating each challenge on this unexpected but ultimately beautiful path.

References

Ackermann, Bronwen, Driscoll, Tim, Kenny, Dianna T. “Musculoskeletal pain and injury in professional orchestral musicians in Australia.” Medical Problems of Performing Artists 27, no.4 (2012): 181–187. DOI:10.21091/mppa.2012.4034.

Alexander, Frederick Matthias. The Use of the Self. London: Orion Publishing, 2001.

Bengtsson, Sara L, et al. “Extensive Piano Practicing Has Regionally Specific Effects on White Matter Development.” *Nature Neuroscience *8 (2005): 1148–1150.

Coyle, Daniel. The Talent Code: Greatness Isn’t Born. It’s Grown. Here’s How. New York: Bantam Dell, 2009.

Johnson, Jennifer. *What Every Violinist Needs to Know About the Body. *Chicago: GIA Publications, 2009.

Madden, Cathy. Integrative Alexander Technique Practice for Performing Artists: Onstage Synergy. Bristol, UK: Intellect, 2014.

———. *Teaching the Alexander Technique: Active Pathways to Integrative Practice. *Philadelphia: Singing Dragon, 2018.