Working Past a Hand Injury on the Clarinet — Part II: Physical Exercises

Photo by Nick Rutter for the University of Cambridge

In Part I of this article, we talked about the often overlooked mental side of working through an injury. Mental toughness and mindfulness are not only beneficial when working through an injury but also essential to being a performer, so I encourage you to read through Part I and explore your own work in these areas. Now I want to give you some practical exercises and tips to try on and off your instrument. These exercises are about establishing finger independence, strength, and control with ease.

Exercises On the Instrument

I recently listened to an interview on Noa Kageyama’s The Bulletproof Musician with guitarist David Leisner discussing how he overcame focal hand dystonia and playing with ease. There were a few key points that I took away and have incorporated into my own practice:

1. Use the large muscles instead of the small muscles.

Many clarinetists and wind players mostly think about using their fingers, wrists, and forearms when playing. We don’t need to move the entire arm to play as a violinist does or the full body like a cellist. We tend to focus on the small muscles which can become overworked and accrue tension and pain easily. If instead you engage the large muscles in your shoulders, chest, and back, you’ll be less likely to strain the little muscles and allow each motion to come with greater ease.

“If you engage with the large muscles and support what the small muscles are doing with the large muscles, it’s virtually impossible to tighten up,” Leisner said.

2. Exaggerate the motions.

When learning or relearning a motion, it’s important to exaggerate the motion at first so your whole system really feels and understands what’s going on. Then from there you can refine and speed up the motions once they begin to feel natural and relaxed. In his interview, Leisner says to make your motions as large as you can get away with in the given tempo as to engage the large muscles.

3. Freedom of motion is more important than economy of motion.

Ease above all else. When working through an injury, don’t worry about accuracy or keeping your fingers super close to the instrument at first. Getting caught up in accuracy and perfection is only going to add to the mental frustration and physical tension you feel. Ease and freedom in your muscles and joints through each motion is what matters most when recovering and retraining the fingers.

Keeping these three ideas in mind, I practice finger independence by working one finger at a time. I begin very slowly with whole notes, followed by half notes, quarter notes, and so on, slurring everything and moving to the next rhythm only if my hand feels completely at ease.

As tempting as it may be to go faster because that’s where you think you should be, do not force movement if your hand isn’t ready. It’s like quicksand or the Devil’s Snare vine from Harry Potter, the more you struggle and force motion, the more resistance you will face in return. Let go, relax, and trust in the slow work you’re doing. Choose the tempo and number of repetitions that best fit you, below is a basic example of the exercise.

Basic finger independence exercise

Once your fingers are feeling more capable of moving with ease at slightly faster tempos again, a variation of the above exercise that you can now add are “bursts”. This allows you to push your current capabilities just a bit further while still remaining relaxed. Rather than moving to the next subdivision in the first example because your fingers can’t make it the entire two measures with ease yet, incorporating just short bursts of motion in the next subdivision gives you the same benefit of training your fingers at a greater speed but allows them to remain relaxed. The below example only shows the last few measures, but begin with whole notes as in the exercise above.

Finger independence exercise ending with “bursts”

Now this is all well and good, but you still have scales and repertoire to work on for your lesson/jury/recital/audition that will happen despite your injury. Practice all that you need to but keep it slow, relaxed, and with large motions for now. With solo repertoire, it can be especially frustrating and discouraging to not be able to play up to tempo when you were able to before… trust me, I know. Accept that it will be frustrating and then trust in your slow, relaxed work.

Practicing in front of a mirror is very beneficial. It allows you to add another element to your retraining of the fingers. Other than the tactile and audio feedback you receive when practicing, now you have visual feedback. Observe what your fingers are doing. Compare to what the other hand is doing. What’s working or not? What’s different between the fingers that are working and aren’t? Is your posture aligned and healthy or are you placing unnecessary strain on the neck that could be affecting your smaller muscles? Observe and experiment based on all of the feedback you are receiving.

Experiment with visualization, too. Clearly see your fingers moving with ease, imagine how it felt when they moved with ease. Experimentation, observation, and adjustments play a huge role in determining what does or doesn’t work for you.

One of the up sides of an injury is that it requires you to look deeper into what you are doing and be very intentional with your motions. Reflecting on the time before my injury, I’ve noticed that I’d not truly paid attention to how my fingers were moving and what allowed them to move so easily. They worked, so I simply didn’t think about them further. With this injury though, I’m made to pay attention and be deliberate in each motion.

Make the most of this unideal time by revisiting and strengthening other aspects of your playing like articulation including tongue stroke and speed, how you start notes, air control, voicing, phrasing, character, etc. In your attempts to fix the technical issues created by your injury, it can be easy to forget about all of the other elements of your playing that still need daily attention and work.

Finally, just a few additional tips to keep in mind:

1. Practice sessions should be shorter than usual at first, spaced out, and with breaks.
2. Avoid using a neck strap if possible to avoid strain on the neck that can further injure your arms and hands. Rest the clarinet on your knees if needed.
3. Stop if you start feeling pain.
4. Consult with a physical therapist or occupational therapist experienced in working with musicians, do your research before deciding on where to go.

Exercises Off the Instrument

By now you probably have a lot to think about and experiment with, so I just want to end with a few exercises you can try without the clarinet. Doing some work off the clarinet is beneficial because (1) it can reduce frustration and anxiety by getting away from the instrument that you feel pressured to play so well and (2) if you want to actively be working towards the improvement of your injury but it’s physically too uncomfortable on your instrument at the moment, you can still strengthen and retrain your muscles. While I use these exercises as a clarinetist, they are applicable to most instrumentalists.

Disclaimer: I am not a physical or occupational therapist, if you are having serious issues or pain, consult with a PT or OT before doing the strength or stretching exercises. Here I will share with you things I do that are generally safe for anyone to do.

Building Strength

1. Finger push-ups: Rest your hand, wrist, and forearm on a flat surface. Raise and lower each finger individually about 10x and then in any combination (e.g. ring and pinky together, fingers 2/3/4, etc.). Keep your fingers gently curved, relaxed, and the knuckles from collapsing. If needed, you can support your ring and pinky finger’s large base knuckles with your opposite hand gently pushing those knuckles upward.
2. Waving from the big knuckles: This is a very short and simple exercise to remind you where the motion in your fingers should come from and how this feels. Simply make a waving motion where you open and close your hand moving from the large knuckles only while the fingers are in a natural, gently curved position. Feel how relaxed and easy it is to move from the large knuckles and imitate this on your instrument.
3. Therapy putty: In the diagram given, I’ve mainly stuck with the Scissor Spread, Thumb Pinch Strengthening, Full Grip, Finger Pinch, Finger Scissor, and Finger Spread Exercises. This is potent medicine, so be careful not to overdo it. Start with just a few reps (5–10x) once a day and a soft strength therapy putty. Consult with a PT or OT before increasing reps and putty strength.

Hand exercises with Therapy Putty. Source: Pinterest

4. Rubber band: I’ve used the rubber band less because the therapy putty is so versatile, but the rubber band is very useful for a full five finger extension as shown in the diagram. Again, be careful not to attempt too many reps. Use a less resistant band and repeat 5–10x.

Rubber Band Extension. Source: pt-helper.com

Reducing Tension

1. Stretches for the large muscles: Incorporate a few basic stretches for your large muscles either when you wake up or right before going to bed to keep your muscles strong, flexible, and allow for greater range of motion in your joints. If muscles become tight, you are more likely to strain or injure them. There are countless lists of basic stretches you can find online. I recommend doing 5-10 stretches, covering the back, chest, shoulders, arms, hips, and legs.
2. Stretches for the small muscles: Similarly, stretching the smaller muscles will maintain strength and flexibility to prevent pain and injury. You can also find ample examples of stretches online. I recommend the Wrist Extension, Wrist Flexion, and Prayer Stretches for your forearms, wrists, and hands. Be careful not to overstretch! Don’t push yourself to the point of pain.
3. Alexander Technique: This method aims to change poor postural habits to improve mobility and performance while reducing stiffness and tension. In my own experience with AT, I’ve become more aware with how I use my body, especially my neck and back. While working with this method, I personally didn’t notice much of a difference in my smaller muscles and hands, BUT this is a method that takes more than a semester’s worth of practice. The Alexander Technique is well-known, taught, and practiced worldwide and has helped countless musicians overcome their injuries.
4. Meditation & Mindfulness: As I mentioned in Part I of this article, actively working on the mental side of an injury is immensely helpful, especially if the injury is caused or worsened by your state of mind (which is virtually all injuries). Figure out what mindfulness work works best for you, whether this be incorporating daily 10-minute meditations or yoga, journaling honestly about your fears and plans or physically writing positive affirmations, saying out loud your reframed positive thoughts in the practice room, going for a walk in nature when you’re feeling frustrated, setting smaller and more attainable practical goals to give yourself needed confidence boosts in the practice room, etc. The ways in which you can work on the mental side of handling your injury are limitless and will be unique to you, so enjoy the exploration!
5. Cold showers: This is relatively new to me but something that a surprising amount of people do. While a cold shower may not solve all of your problems, it can help a bit and that’s worth trying when you’re injured. Cold showers allow for increased blood circulation throughout your body, bringing more blood and oxygen to your injured muscles. The cold water can also help reduce inflammation of overworked muscles and prevent further irritation. On top of this, cold showers can leave you feeling more energized, at ease, and they are supposedly better for your skin and hair too!

Overall Health of Your Body

1. Exercise: Regular physical exercise is essential to keep your mind and body healthy and capable of the stresses it endures. Musicians are athletes and must keep up with the physical demands of our craft. Not to mention, a gym session or a trail run can be the perfect way to decompress and wash away built-up stress. The CDC recommends at least 150 minutes of exercise per week that includes moderate aerobic exercise and strength training.
2. Nutrition: Just like an athlete, you must fuel your body with a proper, balanced diet and water intake. One’s dietary habits are unique to the individual, so I won’t go into it here. I will say, though, that as much as you focus on what you are consuming, be aware of what you are intentionally not consuming. While I have a very balanced diet, I also have a huge sweet tooth and can consume a lot of sugar. Some studies suggest sugar can add to inflammation and therefore joint pain. Though this doesn’t seem to be definitive, do be cognizant of what good and bad you put into your body.
3. Sleep: Similarly to nutrition, the amount of sleep one needs is unique to the individual, though the CDC recommends adults get at least 7 hours of sleep per night while teenagers get at least 8 hours. Proper sleep habits will give your mind and body time to relax, recuperate, and absorb all of the information you input during the day. You will wake up the next day energized and with sharper focus. Rest is essential for growth and improvement.

Mia holds her B.M. in Clarinet Performance from Indiana University and is currently pursuing her masters in this field. With her writing, she aims to shed light on the less conventional and less discussed aspects of being a modern musician.