A worrying number of cellists struggle with back problems, probably due to long hours seated at the cello combined with the strain of carrying a heavy cello case. Teresa Checchia, a cranial osteopath, Kathy Hooley, professional cellist and McTimoney chiropractor and Ann O’Brien, an Alexander Technique teacher all agreed to offer their advice.

Chair design: Every practitioner stressed the importance of using a chair with the right height. Ideally, the front of the chair should be the same height as the lower leg (up to the back of the knee) so that both feet can rest comfortably on the floor without a feeling of either compression or over-stretching. It can also be very helpful to have the back of the chair a little higher than the front as this allows the hip sockets to open more freely as you lean forward to play and also allows the lower back to retain its natural shape. Many cellists use adjustable piano stools so that they can achieve the right height and it is also possible to buy special cello stools which are built with a slightly forward-sloping seat.  A cheaper alternative is to buy a firm wedge-shaped cushion (with between 11 and 15 degrees of slope) to use on your existing chair or stool or to put a wooden bar or blocks under the back legs of your chair to create a slope.  The advantages of angled seating for cellists are explored by Victor Sazer in his article ‘Oh My Aching Back!’ and in detail in his book ‘New Directions in Cello Playing’ which addresses many issues of playing discomfort for cellists.

Posture: In her book, ‘Just Play Naturally’, cellist and Alexander Technique specialist Vivien Mackie describes a photograph of herself when she was already a successful young cellist: ‘I have an old photo of myself at sixteen, slumped and crunched over the cello. And I know how I felt. I know I felt terrible…’ (p56) All the practitioners I spoke to were passionate in their desire for us to think about our posture and state of mind before starting to play. Here are some of their suggestions: Are your feet resting comfortably on the floor? Are your neck and shoulders relaxed? Does the crown of your head feel as though it is floating upwards towards the ceiling like a helium balloon, lengthening your spine? Is your breathing free and chest open – even when playing difficult passages?

Ann advises making good use of the natural hinge points in the body, in order to avoid strain on the back: ‘When leaning forward to play, bend from the hips, not with the spine; the hips are designed to bend in the same place over and over again but the back isn’t designed to bend repeatedly in the same place.’ The other under-used hinge in our bodies is the joint at the very top of the spine, right between the ears. Ann recommends using this ‘nodding’ joint when looking down at music or up at a conductor, instead of hunching the neck and shoulders. Kathy observes that some cellists bear most of their weight down through one side of their bodies when playing: ‘This results in a corkscrew effect, twisting the spine as we move forwards with the right shoulder and backwards with the left. Ideally the shoulders and pelvis should be in line with each other when playing.’

Take regular breaks from sitting whenever you possibly can. Our bodies are designed for movement and not for sitting, so even though you might be practising hard, it’s still important to take an active break every 20 minutes. Walk around, make yourself a drink and allow the body to realign itself before getting back to work. Alternatively, you could lie in the semi-supine position for a few minutes to relax and unwind (see below). If in the middle of a performance, Kathy advises cellists to wriggle in their chairs, arching and flexing the back forwards, backwards and from side to side.

Stop: If you are tired, uncomfortable or feeling stressed, stop. Vivien Mackie first learned this lesson from Pablo Casals, and then from her Alexander teacher. ‘You need to be able to say to yourself, “Stop, and stay where you are,” and then you have to ask your neck to be free in such a way that your head can go forward and up, so that your back can lengthen and widen… and this puts you into a completely different place for arranging at the subconscious level your next action, whatever it may be,’ (Just Play Naturally, p.65) Ann encourages her clients to create a feeling of stillness in a nanosecond, just by stopping and detaching the mind.

Try to get a light case and use rucksack style straps. Hauling cello cases around probably causes the most damage to cellists’ backs, partly due to the weight of the case compressing the spine and also the asymmetrical way we tend to carry cello cases. ‘Humans are symmetrical creatures and carrying something as heavy as a cello case on one side of the body is unlikely to do you any good in the long term, unless you are very robust,’ Ann reasons. Compared to the cost of long-term therapy after a back injury, buying a light carbon fibre case with rucksack-style straps could be an economical option: a carbon fibre case can weigh as little as 3.1kg compared with a traditional fibreglass case weighing 6 or 7kg. If you have wheels on your case, it’s worth using them whenever you can.

The moment of picking up a case can be the most dangerous to the back, particularly if the action is done in a hurry, with a braced, tense body. Ann and Teresa advise cellists to use their bodies in a fluid, elastic way at all times: ‘A tense muscle group is compromised by that tension – it is much more brittle and liable to injury’, Teresa explains. Ann suggests that you stop and prepare yourself for a moment, release your neck muscles, think of lengthening your whole back and keep the body elastic as you pick up the case; Kathy warns against jerking or twisting movements. If you are carrying the cello for a long distance, stop and take short breaks, putting the cello down so you can gently free up the body.

Exercise: Taking regular, balanced exercise is one of the best routes to a healthy back but the pressures of work can all too easily distract us from taking care of ourselves. Teresa encourages her patients to take exercise in the form of walking (hill walking is particularly good) and attending Pilates classes. She also recommends singing to open the chest and lungs. Kathy advises bilateral exercise such as swimming or walking to keep the body balanced.  Ann also believes that walking is one of the best forms of exercise for the lower back; a study published in the British Medical Journal shows walking to be particularly good for people suffering from chronic back pain, especially when combined with a series of Alexander Technique lessons.  Here’s a link to the BMJ article: www.bmj.com/cgi/content/full/337/aug19_2/a884

Active resting: One of the safest exercises to help maintain the health of the lower back or to help healing in an injured back is the Alexander Semi-Supine position. Lie on your back on a firm but comfortable surface (e.g. a carpeted floor) for 15 minutes a day with your knees bent in line with your hips and your hands resting on your abdomen. Place some paperback books under your head at the back of your skull, so that the back of the neck is unobstructed. Keeping your eyes open, try to distribute your weight evenly between the back of your head, your shoulder blades, lower back and feet. Then allow your head to sink back into the books, let your body release into the floor, think about your spine lengthening and back widening and your knees pointing up to the ceiling.

This exercise not only allows the body to release tension, rest and lengthen, rehydrating the discs in the spine, but also prepares the body for better posture and self awareness during the rest of your day. If there isn’t time for a full 15 minutes, even 5 minutes spent in this position can make a big improvement to the way you feel.

Another way to unwind is to follow a relaxation exercise while lying or sitting; Simple Relaxation by Laura Mitchell is the classic approach and is very effective.

Injury: So far we have been looking at ways of preventing back problems but what if you already have a chronic condition or a recent injury which is undermining your ability to play or interfering with your life? The first step should always be to consult a doctor. Most back pain is caused by muscular problems but in rare occasions it can be the symptom of a more serious and seemly unrelated problem, such as kidney stones. Once the doctor has checked the symptoms they will be able to prescribe suitable pain relief in the short term and if necessary, refer you for a scan or for physiotherapy.

Those with ongoing back problems may already work with a trusted practitioner such as a physiotherapist, osteopath, acupuncturist or chiropractor. But it can be very difficult to know whom to consult when you first have an injury. The challenge is to find a practitioner with whom you feel safe, who listens carefully to everything you say and to whom you can express your symptoms, doubts and fears.

Choosing a practitioner: I am increasingly drawn to a philosophy of ‘less is more’ when dealing with any health issue. The body is a sensitive and complex system and I believe it is helpful to be treated as gently as possible. Mainstream osteopathy and chiropractic both have a fairly ‘macho’ image but within both disciplines there are gentler branches of practice. As a McTimoney chiropractor, Kathy works to adjust the bones of the whole body to maintain correct alignment of the spine and to ensure the body’s nerve supply works as efficiently as possible; the difference with this approach from other methods of chiropractic is its speed, accuracy and gentleness, checking patients from head to toe during every session.

Teresa Checchia specialises in cranial osteopathy, an approach which treats the whole body via gentle stimulation of the fascia (inter-muscular tissues). I was lucky enough to work with Teresa years ago when she practised in Ely.  A significant proportion of her clients are professional musicians who have been referred to her with injuries or a repetitive strain condition. The term ‘cranial’ covers a whole range of gentle osteopathic techniques applied to the body as a whole, not just to the cranium, as Teresa explains: ‘Cranial techniques are helpful in healing soft tissue injuries and are useful for low back problems as well as small joint strains or injuries, such as hand, arm and shoulder which can manifest for cellists. Musicians tend to be very sensitive individuals who require fine tuning and care, just like musical instruments. As well as treating injuries, cranial techniques can make a huge difference to a musician’s mobility and alignment, but once this is achieved I always encourage my patients to work with an Alexander Technique teacher in order to learn how to use and maintain that increased mobility. If you want a long playing life, you have to invest in the self awareness and training to maintain a fluid, flexible and toned body.’

Case History: My lower back went into spasm after a dance class two years ago and I was desperate to get moving again. Two male friends had been successfully treated for similar symptoms by a local physiotherapist using a powerful tens machine so I went for a couple of sessions, hoping for a ‘quick fix’. Unfortunately the spasm then became so acute that I couldn’t get out of bed. My doctor prescribed powerful pain relief and insisted I get up straight away; research shows that the sooner you move around using pain relief, the sooner the spasm abates. He also referred me to a senior NHS physiotherapist.

I took pain killers and had regular acupuncture for eight weeks but was still very sore and stiff when I finally saw the physiotherapist three months after the injury. Her main concern was the total absence of movement in my lower back: the muscles were still very tight after the injury but apparently I was also unconsciously guarding the back against any movement. She explained that during and after a muscle spasm the spine is immobilised, which in turn limits blood supply to the injured area and inhibits the efficient delivery of nutrients and clearing of toxins, thus preventing full healing. If you have experienced acute back pain you will know how alarming it is to start moving the back again but my physiotherapist explained the secret: to make very gentle, subtle movements which cause no pain. The brain then receives a positive message that movement is not dangerous and will in turn accept more movement in the back. Week by week, I was prescribed larger movements until, several months later, my back was moving normally for the first time in years.

Having a back problem is worrying and painful but it can also provide an opportunity to stop and think about the way we’ve been using our bodies. Injury can increase physical and emotional self-awareness in a positive way, while a vulnerable back encourages you to stop and think before picking up a heavy cello case or an oppressive work load. Stopping and reflecting for a few moments can prevent further injury and also allow life to flow a little more gently. Working with a good health practitioner and taking more exercise can also help the mind and body to become more elastic in the face of life’s many challenges.

© Sarah Mnatzaganian 2009

Professional organisations:

Society of Teachers of The Alexander Technique: www.alexandertechnique.co.uk
UK Organisation for Cranial Osteopathy: www.cranial.co.uk/
McTimoney Chiropractic Association: www.mctimoney-chiropractic.org

Reading list:

Elizabeth Andrews: Healthy Practice for Musicians

Barbara Paull & Christine Harrison: The Athletic Musician: advice on how to take care of your shoulders and back

Barry Green with W. Timothy Gallwey: The Inner Game of Music: Psychology for musicians

Pedro de Alcantara: Indirect Procedures: applying Alexander Technique to musical performance.

Vivien Mackie and Joe Armstrong: Just Play Naturally: an account of Vivien Mackie’s study with Pablo Casals in the 1950’s and her discovery of the resonance between his teaching and the principles of the Alexander Technique.

Laura Mitchell: Simple Relaxation: a Physiological Method for Easing Tension

Victor Sazer: New Directions in Cello Playing

Useful site on health for musicians with a long list of good links: www.rsi.unl.edu/music.html

© Sarah Mnatzaganian 2009

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