see: Music and Medicine on Mondays at the University of Iowa - Schedule of Events

protocol page initiated Feb 2024 Piper Wenzel BS, Henry Hoffman MD

content created August 2024 by Evgeniya Molotkova BS

Bows Used for Double Bass Explained (60 seconds)

video of full interview and performance

Definitions

• Ergonomics –
  • "an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely" (Merriam-Webster 2024)
  • the design of work tasks to best suit the capabilities of workers, which can help reduce musculoskeletal disorders/injuries (www.cdc.gov) 
• Musculoskeletal – relating to the muscles and skeleton, including structures like joints, tendons, and ligaments (www.dictionary.cambridge.org) 
• Register – the range of pitch that is perceived by the listener, lower pitch/larger instruments correspond to a lower register (Patterson et al, 2010) 
• Splinting – use of a rigid or flexible material to protect, immobilize, or restrict motion in a certain part of the body (Fess, 2002) 
• Carpal tunnel syndrome – numbness, tingling, and pain that occurs in the hand/wrist due to compression of the median nerve as it enters the hand from the wrist (Genova et al, 2020) 
• Rotator cuff – colloquial term for the muscles that support the shoulder and includes the supraspinatus, infraspinatus, teres minor, and subscapularis (Tytherleigh-Strong, 2001) 

Background

Musicians, much like athletes, perform repetitive movements that may make them susceptible to musculoskeletal injury. The exact type and pattern of injury depends on many factors, but one of the most important ones is what instrument they play and the ergonomics of how they do it. In one electronic survey, only 42% of musicians with a chief complaint of musculoskeletal pain reported getting a formal diagnosis from a healthcare provider (Yang et al, 2021). This underscores the need for a better understanding of the physical challenges faced by musicians and how healthcare providers can better address them. Below is an outline of some of the ergonomic considerations at play that may either prevent or cause injury and a review of the strategies that are used to treat symptoms/injuries as they arise. 

Ergonomic Considerations

• Height/size of the musician 
  • The bass come in a variety of sizes, and the size should be chosen based on a musician’s age and height. Most adults will play a 3/4 bass (Bridgewood & Neitzert) 
    • An important consideration in choosing the correct size of bass is the length of the musician’s arms, which influences finger positioning and proper posture while playing (Chanphanitpornkit and Yi, 2021) 
• Proper posture and instrument positioning (Chanphanitpornkit and Yi, 2021) 
  • The musician should not lean on the bass to get closer. Instead, the instrument should physically be brought closer to the musician 
  • Sitting down is generally regarded as being more comfortable 
  • Adjusting the endpin will ensure that the angles at the shoulder and elbow are comfortable, as they need to be sustained throughout a performance 
• Position while playing the bass 
  • Playing the bass requires sustained, asymmetrical postures, which can cause pain and injury (Yang et al, 2021) 
  • The musician may choose to sit or stand while playing the bass. Traditionally, musicians that play solo will stand, and musicians that play in an orchestra sit. Nowadays, it is uncommon for musicians to be equally proficient in both positions and will typically choose a position they are more comfortable with (Wikipedia, 2024). 
    • Sitting (Yang et al, 2021)(Brandfonbrener, 2003) 
      • Poor posture associated with weak trunk control or use of non-supportive chairs can cause muscle fatigue, muscle tightness, and back pain 
    • Standing (Yang et al, 2021)(Brandfonbrener, 2003) 
      • Standing or perching on top of a stool in the context of poor posture and a weak core can also cause back pain 
  • In a 2015 study of music performance students, researchers found that a slumped posture was more common than an upright one, suggesting that sitting (versus standing) is a risk factor for poor posture (Blanco-Piñeiro et al, 2015) 
• Finger positioning 
  • Supporting and playing the bass requires a lot of shoulder strength and scapular stabilization. In beginner musicians, weakness in these structures can cause increased wrist flexion and thumb hyperextension 
    • This results in excessive tension on the neck of the bass and manifests clinically as thumb, wrist, and forearm pain. It can also cause paresthesia at the fingertips, especially with prolonged playing (Yang et al, 2021) 
• Type of bow used 
  • Bass bows are composed of strings held in place by a frog, adjusted by a tension screw at one end, and tapering to a tip on the other. There are two types of bows used in bass performance – German and French. 
    • Compared to the German bow, the French bow has a smaller frog, similar to bows used to play cello and violin (Gollihur, 2024) 
  • Structural differences between the two bows demands a different grip 
    • French (Green, 1973) (Gollihur, 2024) 
      • The wrist lies parallel or on top of the bow in an overhand grip, utilizing the thumb and the index finger 
    • German (Green, 1973) (Gollihur, 2024) 
      • The wrist lies perpendicular to the bow with an underhand grip, utilizing the strength of the thumb and back of the hand 
  • Regardless of the bow used, the motion at the shoulder remains the same if the grip is correct 
• Transporting the instrument 
  • The double bass is a large instrument, and with the carrying case, can also be heavy 
    • This can make it difficult to both maneuver and carry 
  • The CDC/NIOSH provides useful guidelines for lifting heavy objects and preventing workplace injuries (www.cdc.gov) 
    • Use both hands if possible 
    • During the lift, the object should ideally be positioned above the knees, below the shoulders, and close to the body 
    • The lift should be done in one, steady movement, without rapid jerking 
    • Utilize the help of others or tools like dollies to facilitate movement 

Management/Prevention

Sudden increases in playing time or intensity, such as before an important audition, is a recognized risk factor for musculoskeletal problems in all musicians. Other risk factors for musculoskeletal injury include poor conditioning, small hand/arm size, and being double-jointed. Because these risk factors exist at the musician level, it is recommended that teaching to prevent injuries should be individualized for the best results (Brandfonbrener, 2003). 

• Common injuries 
  • Rotator cuff 
    • Double bass players must sustain asymmetrical muscle tension as they are holding and playing their instrument. This tension lies mostly in the rotator cuff muscles, causing muscle fatigue (Levenderis, 2022)  
• Warming up and cooling down 
  • Warming up 
    • This can take the form of playing slowly on the instrument or performing a neuromuscular warmup of body structures that will be involved in play (Zaza, 1994) 
  • Cooling down 
    • This refers to stretching after performing. Stretching has been studied thoroughly in athletes, but not as much in musicians. Generally, stretching is regarded to be not harmful, but additional work must be done in musicians to characterize its utility (Zaza, 1994) 
• Treatment and prevention strategies (Yang et al, 2021) 
  • Elastic taping 
    • Taping can provide proprioceptive feedback to musicians that can help them alter their grip and playing ergonomics. Video, either in lieu of or in combination with, this technique can also help identify areas of improvement. 
  • Splinting/orthoses 
    • Both techniques can be utilized to maintain hand placement to either correct poor grip/posture or help a musician recover from an injury 
  • Changing bows 
    • Bows made of lighter carbon-based material are available for purchase and use during recovery from an injury 
• Rest (Zaza, 1994) 
  • Time off 
    • Recommendations on the timing, duration, and frequency of breaks while playing vary 
      • Musicians should not be performing repetitive motions like those involved in playing their instrument during breaks 
      • Additionally, musicians should be cautioned in their choice of activity in time off with careful consideration of which parts of their body will be used 
        • For example, a musician who plays a string instrument should not take up knitting in their free time 
• Pacing during playing 
  • A sudden increase in duration or intensity of activity is positively associated with musculoskeletal injury 
• Cognitive/mind rehearsals 
  • As the name suggests, this involves the musician visualizing themselves preforming  
  • Cognitive rehearsals can also help musicians master a particular skill or musical piece 
    • Research shows that complex skills, such as playing an instrument, can be mastered quicker when learned by a combination of physical and cognitive practice 

References

“About Ergonomics and Work-Related Musculoskeletal Disorders.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/niosh/ergonomics/about/index.html. Accessed 26 Aug. 2024. 

“Musculoskeletal | English Meaning - Cambridge Dictionary.” Cambridge Dictionary, dictionary.cambridge.org/dictionary/english/musculoskeletal. Accessed 26 Aug. 2024. 

Patterson, R.D., Gaudrain, E., Walters, T.C. (2010). The Perception of Family and Register in Musical Tones. In: Riess Jones, M., Fay, R., Popper, A. (eds) Music Perception. Springer Handbook of Auditory Research, vol 36. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6114-3_2 

Fess, Elaine Ewing. “A history of splinting: To understand the present, view the past.” Journal of Hand Therapy, vol. 15, no. 2, Apr. 2002, pp. 97–132, https://doi.org/10.1053/hanthe.2002.v15.0150091. 

Tytherleigh-Strong, Graham FRCS(Orth), DSportMed; Hirahara, Alan MD; Miniaci, Anthony MD, FRCSC. Rotator cuff disease. Current Opinion in Rheumatology 13(2):p 135-145, March 2001. 

Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal Tunnel Syndrome: A Review of Literature. Cureus. 2020 Mar 19;12(3):e7333. doi: 10.7759/cureus.7333. PMID: 32313774; PMCID: PMC7164699. 

“Double Bass Size Guide.” Bridgewood & Neitzert, bridgewoodandneitzert.london/double-bass-size-guide-i27. Accessed 23 Aug. 2024.  

Chanphanitpornkit, T., & Yi, T. S. (2021). All About that Bass, No Treble: Shapeshifting from Violin to Double Bass. American String Teacher, 71(3), 33-38. https://doi.org/10.1177/00031313211024541 

“Double Bass.” Wikipedia, Wikimedia Foundation, 13 Aug. 2024, en.wikipedia.org/wiki/Double_bass.  

Yang, N., et al. “A musician-centered approach to management of performance-related upper musculoskeletal injuries.” Journal of Hand Therapy, vol. 34, no. 2, Apr. 2021, pp. 208–216, https://doi.org/10.1016/j.jht.2021.04.006.  

Brandfonbrener, Alice G. “Musculoskeletal problems of instrumental musicians.” Hand Clinics, vol. 19, no. 2, May 2003, pp. 231–239, https://doi.org/10.1016/s0749-0712(02)00100-2.  

Blanco-Piñeiro, Patricia, et al. “Common postural defects among music students.” Journal of Bodywork and Movement Therapies, vol. 19, no. 3, July 2015, pp. 565–572, https://doi.org/10.1016/j.jbmt.2015.04.005.  

Gollihur, Mark. “French or German Bow - Which Should I Choose?” The Differences Between French and German Double Bass Bows, gollihurmusic.com/french-or-german-bow-which-should-i-choose/. Accessed 26 Aug. 2024. 

Green, B. (1973). String Bassists Disagree. American String Teacher, 23(2), 34 38. https://doi.org/10.1177/000313137302300224 

“Ergonomic Guidelines for Manual Material Handling.” Centers for Disease Control and Prevention, www.cdc.gov/niosh/docs/2007-131/pdfs/2007-131.pdf. Accessed 26 Aug. 2024. 

Levenderis, Frances. “The Prevalence of Musculoskeletal Symptoms in Double Bass Players.” Stellenbosch University, 2022. 

Merriam Webster on-line dictionary defining 'Ergonomics' (<https://www.merriam-webster.com/dictionary/ergonomics  accessed 9-2-2024>)

Zaza, Christine. “Research-Based Prevention for Musicians.” Medical Problems of Performing Artists, vol. 9, no. 1, 1994, pp. 3–6. JSTOR, http://www.jstor.org/stable/45440474. Accessed 26 Aug. 2024. 

Kelleher LK, Campbell KR, Dickey JP. Biomechanical research on bowed string musicians: a scoping study. Med Probl Perform Art. 2013 Dec;28(4):212-8. PMID: 24337033.

Woldendorp KH, Boonstra AM, Tijsma A, Arendzen JH, Reneman MF. No association between posture and musculoskeletal complaints in a professional bassist sample. Eur J Pain. 2016 Mar;20(3):399-407. doi: 10.1002/ejp.740. Epub 2015 Sep 1. PMID: 26332347

Woldendorp KH, Boonstra AM, Arendzen JH, Reneman MF. Variation in occupational exposure associated with musculoskeletal complaints: a cross-sectional study among professional bassists. Int Arch Occup Environ Health. 2018 Feb;91(2):215-223. doi: 10.1007/s00420-017-1264-5. Epub 2017 Oct 20. PMID: 29052757; PMCID: PMC5797213