Injury in Musicians: Flutist

Sports injury is not a new term and everyone can understand the relationship between sports and injury. However, do you realize injury to musicians is common as well?

Association with the Amount of Practice
It may sound strange at first to hear of injuries being associated with the playing of music. But it's less difficult to understand when comparing it to marathon runners. Statistics show injuries increase tremendously when the runners run more than 19 miles a week. It's obvious there is a limit to how much physical stress our bodies can withstand before injuries occur. My daughter practices 1–2 hours a day, and she is already in pain. Many musicians practice over six hours a day, and I believe most of them live with pain to varying degrees.

What is the Physical Stress in Musicians?
The physical stress occurs in the posture the musicians hold while playing their instruments, the movement required to make the music, and the duration of the practice.

  • Posture (Flute)
    Each instrument requires a specific posture to hold it. The posture for holding a flute is extremely asymmetrical. In general, it requires rotation of the head to the left. In addition, some people also poke the head forward, or they rotate the upper body to the right. Some flutists may also tilt their head down to the right side in order to relieve some effort from their right shoulder.
  • Movement
    This can be easily understood in piano players. Tendonitis in the hand is a common injury for pianists.  It is directly related to the repetitive movement required.
  • Duration of Practice
    It is not the total time of practice, but how long the musician plays without taking a break. It goes back to the point of how long a musician remains in one posture and for how long she repeats the same movement.

Potential Injuries in Flutists
The prolonged head rotation posture will overload the (right) sternocleidomastoid (SCM) muscle. This will be worse if the flutist also tilts her head to the right. The sternocleidomastoid is the muscle which runs diagonally from behind the ear to the collar bone and the chest bone. It is so superficial you can see and grab it with your fingers. This muscle is innervated by both sensory and motor nerves. When the muscle develops restriction and trigger points, it can refer pain to the ear and eye and make a person feel dizzy and nauseated.

The other common injury is strain to the upper fibers of the trapezius muscle due to forward head posture. The trapezius lies on top of the body between the neck and the shoulder. The restriction developed in this muscle is so common among flutists, it has given way to the term "flute knot."



  • The best preventive treatment is to avoid prolonged practice without breaks. A few minute break from the same posture will allow muscles to relax and recover.
  • Frequent stretching will counteract the tendency for muscles to tighten up or adapting to the shortened position. To stretch the right SCM, tilt your head to the left side and to turn to the right at the same time. To stretch the right upper fibers of trapezius, tilt your head to the left, turn to the left, and bend forward at the same time.


Playing music is enjoyable. I hope these tips can help.

Peggy Hau, PT, MscPT is a licensed physical therapist at Mettler Center. Musculoskeletal pain is best evaluated by a physical therapist who can detect functional problems and make the best possible recommendation for treatment. Call 217-398-9800 to schedule a free 30-minute consultation with a physical therapist or request an appointment online.