Violinist with neck and left arm pain


Evaluation on 10/31/17


22 year old violinist is not sure he will be well enough to participate in his rehearsals and two performances of two 15-minute programs, due to symptoms.

Main complaints:   

6-7/10 numbness/discomfort in left arm

Occasional tingles into left hand

Chronically tense neck


Medical diagnosis: 

“Temporary neck seizures or migraine”

MRI taken November 2, the next day after the performances

Nothing clinically significant found

Significant Findings

Forward head posture - which makes head tilt back
Shoulder blades "depressed" (too low)
Kyphosis - excessively rounded upper back
He bends from his spine too often and too much, rather than from his hips 

movement system diagnosis

Cervical Extension syndrome:  His head deviates forward too much

Scapular anterior tilt:  His shoulder blades are titled forward too much

Scapular depression:  His shoulder blades lie too low

Treatments: exercises

- Head retraction exercise to decrease forward head and cervical extension
- Walk without letting trunk collapse and head to come forward
- Arm raises to elevate and posteriorly tilt scapula
- Train to move from hip joints, not neck or back, for bending forward while sitting and standing.

treatments: Strategies

- Identify all the alignments and movements that increase symptoms, and try to eliminate them.
- Work on computer without collapsing from spine.  (Avoid working in bed, or make it more suitable.)
- Modify chin/shoulder rest height
- Increase height of music stand
- Alter alignment and movements as soon as symptoms come on, in order to diminish them.  
- Use a timer when using computer to take measured breaks.  On the break, do the arm raise exercise and/or head retractions to reverse the effects of poor posture.


Nov 15

"I am doing very well.  Here are my answers to the questions:
1. I can tell for sure that my tendency to elevate my left shoulder has aligned my upper body in a way that causes temporary pain in neck and left arm. 
2. I think exercises - especially doing frequent head retraction - had a lot to do with my improvement. I realized now I tend to play in a more neutral position, with chin barely touching the chinrest.
3. Taking a break more often while practicing/rehearsing seems important. Now I take a break every half an hour."

Dec 4

"Now I can say with assurance that these symptoms were results of sustaining body positions that are not neutral, for they gradually disappeared as I worked with you on neutralizing my neck and arm positions. When I first experienced left arm discomfort was when the intensity was highest, probably 6~7 out of 10. During rehearsals in Caramoor, the symptoms relieved, maybe to 3~4."

Dec 13

"1. The headache only lasted for a day or two when I first felt the symptoms. I think I was so frightened at first and that the headache had to do more with some psychological fear....?

2. My doctor's diagnosis was migraine (which happens without headache) and neck seizure: he thought migraine was more probable, as neck seizure rarely occurs to someone in my age.
I think my arm is fully recovered now. I will update you whenever discomfort reoccurs."



Rounded back led to a forward head


Low Music stand Caused symptoms


              Raising music stand alleviated symptoms

Bending too much from spine puts neck at risk

Bending too much from spine puts neck at risk

            Bending from hip joints protects the neck

            Bending from hip joints protects the neck

                             Forward head  

                             Forward head  

      Subtle head retraction improved symptoms

      Subtle head retraction improved symptoms