The Free-Reed Journal

Articles and Essays Featuring Classical Free-Reed Instruments and Performers

The Accordion: A Back Breaker Part One: Case Histories compiled by Henry Doktorski

The incidence of back problems among accordionists is too frequent to be simply dismissed as coincidence. The following is the first installment of a series of articles which address this occupational hazard.

As I play the accordion more and more, I am discovering a real down side to the instrument. My back hurts -- a lot. I have a stand for the accordion and try to pick up the instrument carefully, bending my knees. I play a slightly smaller sized model, and I avoid carrying it whenever I can, usually enlisting my husband to lug it around in the case. Nothing helps. Do others have this problem?

Please forgive my pessimism, but after years of experience I have come to the conclusion that back problems are a natural occupational hazard for accordionists, just as deformed jaws are a natural occupational hazard for violinists, bent teeth are a natural occupational hazard for trumpet players, and tennis elbow is a natural occupational hazard for tennis players.

My Dutch friend, Wim Wakker, was an accomplished concert accordionist until recurring back pain forced him to abandon the instrument completely. Since then he has taken to the concertina (a much lighter and back-friendly instrument) and has had success as a concert artist.

I attribute accordion playing to be a major factor in the incredibly painful herniated disc I had in July 1996. In May I increased my practice time in preparation for several California recitals and soon had a sore back. Immediately I reduced my practicing and the pain reduced, but never went away.

While in California I visited a massage therapist for muscle tension in my legs. Little did I know that my lower lumbar number 3 disc was slowly squeezing out of it's slot in my spine and pressing against the sciatica nerve which goes into my left leg! Ha! I thought it was sore muscles from all the bicycle riding I liked to do.

Anyway, when the disc finally popped out, I had a friend drive me to the nearest hospital emergency room where they filled me up with motrin. The pain was the greatest I have ever had. But the motrin didn't remove the pain, just make it tolerable.

I was pretty much incapacitated for 2 weeks and it took six months before I could walk without a limp. 1.5 years later, I still have to be very careful; I don't dare ride a bicycle, or sit in a chair for more than a half hour, or practice too much! Although I managed to perform at the Tanglewood Festival in August 96 with great difficulty (I walked on stage with the speed of a turtle!) I played my lightweight stradella accordion, not my heavy free-bass accordion.

It was close to a year before I dared to pick up my big accordion again!

Of course, one can minimize stress to the back by utilizing efficient playing positions. The straps should be tight enough to hold the accordion firmly but loose enough that the entire weight of the instrument rests on one's legs, not on one's back.

I believe that I WAS using the proper position. However, I think the stress to my back may have been caused by the left arm pushing and pulling the bellows. Playing sforzando passages caused a great amount of tension throughout the body, not just in the arm muscles. Playing pianissimo has a much gentler effect on the back.

I think this is particular to the accordion, as only the left hand has the job of forcing air in and out of the bellows; this makes the body tense up as it is unbalanced. Concertina and bandoneon players do not have this problem, as they pump with BOTH hands and their bodies are more balanced and less stressed while playing.

My personal opinion? Those who pump away on the accordion for decades and decades without any back problems are genetically blessed with backs of steel!

Those of us with less hearty backs must be extremely careful, or else we suffer!

From: Joe Natoli -- jnatoli@sygnet.com

This really hits home for me because I end up at the chiropractor constantly when I am playing the accordion...especially now that I am getting older (44). It never really bothered me until I reached the age of about 25....then it never stopped bothering me.

You're right, it is an occupational hazard (for some, not all) players. Some never seem to be affected by it (in fact, look at the unbelievable[ly horrible] playing posture of Van Damme all those years and it never seemed to affect him).

But when you think of the weight and the pull on the spine and neck area from the straps, it's no wonder more people don't develop problems. Funny though, I enjoy playing so much that I never notice it during playing...only after.

From: Wim Wakker -- wwakker@tref.nl

Although I don't feel that my 'story' is that unusual for an accordionist, I'll be happy to tell it again.

During the last years of my study at the Sweelinck Conservatory in Amsterdam, I started to notice a numb feeling and stiffness in my hands and arms sometimes after a few hours of practicing. Because I used to practice long hours, usually between 4 and 6 hours per day, I thought it was a sign of over usage. I remember it only occurred when I played accordion, not piano. When the numbness got worse and I started to get severe headaches I went to see Ans Samama, a well known Mensendieck therapist who specialized in musicians.

She taught me how to use my muscles more efficiently and corrected my posture. I remember she also commented on the instrument. She called it a monster, and wondered why people would want to play on these heavy instruments ( I played on a Victoria/Titano special SDG concert model). After a year of almost weekly therapy I did my final recital. I remember that the stiffness had gotten worse and created problems in staccato phrases. I remember I really had to 'work' through the prelude of Bach's English Suite no.3 and Ole Schmidt's toccata. during my exam.

After I graduated I accepted an invitation of the University of Denver, to study with Robert Davine. I hoped that the physical problems would disappear if I would do the daily Mensendieck exercises, but they didn't. I developed severe migraines every time I practiced for more than half an hour. It got to a point that I had to stop doing recitals. I've notice that many colleagues suffer from the same physical problems and are also forced to quit playing. Recently I heard that even Mogens Ellegaard suffered from back/shoulder problems.

Playing accordion has worn down my neck vertebrae to a point that I can not play professionally anymore. I still teach accordion at music schools in Holland and Belgium, but I have use a small converter instrument. After a while you accept it and find another instrument to concentrate on. For me it has been the English concertina. It combines my interest in 19th century music and my interest in free reed instruments. It still puzzles me that no professional accordionist before me ever looked into this instrument. It has that one thing that the accordion has not, and that still prevents it from being fully accepted; a vast original (tonal) concert repertoire from before 1900, equal in quality and quantity to that of the flute, clarinet, etc. that still has to be discovered.

From: Chris Newport -- junk.bin@andante.demon.co.uk

I was recently privileged to spend an evening with James Crabb, who is a personal friend of my daughter's piano teacher and was in London to perform in the Martinu festival at the Barbican centre.

James also suffers from back problems, even though he is still quite young (early 30s I would estimate). Perhaps not surprising as he came by public transport carrying the Pigini!

Editors Note: James Crabb performed with Geir Draugsvoll on the CD titled Classical Accordion which was reviewed in The Free-Reed Review..

From: Terry Knight -- korbo@pied-crow.com

Dear Group,

I too have known several PA players who have been vexed by these back problems .. even players ten or fifteen years younger than myself .. even players who have serious athletic involvement and participate in community sports and jog four or five times a week.

As I think of this, I recall warehouse and workplace posters which advise how TO and how NOT TO pick up heavy objects .. also, I think of all the laborers I have seen in recent years who wear some sort of reinforcing garment on the outside of their workclothes .. supposedly to protect their backs. It's no wonder that we have back problems.

Think of how little care you might give to snatching an accordion up off the ground by the straps. It's not so bad with a smaller PA, but if you have an instrument that has five sets of reeds on both sides and full cassoto, you could find yourself a poster child for the back health campaign.

A sport medicine physician could probably prescribe a regimen of exercises that would go a long way toward strengthening and protecting the back, and could also probably give good advice (patient education) on DOs and DON'Ts. Also, it would probably be smart to make sure we get enough calcium in our diets. Most importantly though, we should remember to use good lifting practices and to heed (HEED) the warning signs (back cramps, stabbing or radiating pains, that kind of stuff).

Maybe this approach could help. Then all we would have to worry about is carpal tunnel syndrome, bursitis, and accordion elbow (or am I the only one who has had these problems as a result of prolonged practicing?).

From: James Fitchett -- j.a.fitchett@stir.ac.uk

Scotland UK

Date: 1 May 1998 04:24:18 -0400

120 Bass Piano Accordions are great instruments for sure, they look and sound great, but they do present a few problems for the beginner (well my 120 did for me). The first thing is that tend to be heavy and cumbersome. This is not a problem if you intend to learn to play the box in your basement by yourself but if you want to get out and play in clubs and want to meet other box players, this can be a problem. I used to find that when I carried the box around, the weight of the box used to weaken my fingers so much that by the time I got where I was going, I couldn't play a note let alone a tune.

From: "Robert Berta" -- RKB4@pge.com

I have been following this thread with much interest since my Profession is Safety Professional with special emphasis in ergonomics. I know Henry personally and while I can certainly feel his pain (now where did I hear that before) I have some info to add to this discussion.

First...surprisingly playing accordion is most likely going to strengthen your back! While back injuries are common to many people, one of the most famous ergonomists (a doctor) told me that the accordion is one of the most perfect ergonomically designed instruments. It is very important though to have the accordion correctly fitted with the various straps and he suggested that you never play one without the addition of a back strap (the one that connects the two shoulder straps a little below your shoulder blades.

Most of the problems from accordion don't come from playing it but from picking it up and taking it off...or carrying it in its case long distances. You need to practice good lifting technique. This means bending your legs in the oft quoted manner but more importantly keep your complete back in a neutral position. Many people assume wrongly that the back needs to be kept straight....the back isn't "straight" but has a natural curve when in the neutral position.

Many people will think they are keeping their back straight but instead are bending from the point on your back at the small of the back. The correct way is to bend at the joints where your leg bone connects to the hip. The pelvic bones need to be kept aligned with the spine. A somewhat humorous way to remember this is "stick your butt out". When playing the accordion you also need to not slouch and have an accordion that is appropriately sized for your body size. I often see huge accordions on teeny people or straps so badly adjusted that the accordion sits at awkward positions.

The doctor I mentioned earlier played accordion...he said that the hand position of the bass and trebles sides keeps your hands in a naturally neutral position which is far superior to the position most other instruments force you into.

For those who still have a problem with the weight of their accordion there are a few solutions. First is to try sitting down....but do it in a chair that is high enough to allow you to not feel crowded. Most people play from chairs like folding chairs but in reality these are too low for the average player. I use a drummers throne....a stool that can be moved up and down like a piano stool. I find that the most comfortable spot tends to be quite a bit higher than what most would assume. As a guideline try setting your stool so that the height is about the same as the width across your accordion case (widest dimension).

Next solution for those who need to stand up when playing is to get a stand for their accordion to help support it. There are a couple of variations I have seen and owned. One is a stand that actually will support the complete accordion without any support from the player. This is seen in Europe quite a bit. The other one is a monopod that clicks into the bottom of the accordion and acts as a aid to support although the player still needs to balance it on the monopod. I owned this device for a while for an old very heavy accordion (about 40+ lbs) and it worked like a charm.

Finally, when used correctly an accordion will actually help develop stronger back muscles....just use correct positioning and don't use bad posture or do stupid things like twisting and bending at the same time.

From: Steve Navoyoski -- snav88@aol.com

Try doing lumbar exercises daily to keep them strengthened, and walking will help. It's the box players that avoid keeping in shape that suffer the most. Most of the problem stems from straining the long muscle in the back, and while chiropractic treatments tend to assist in relieving the muscle pull by skeletal re-alignment, the muscle is still under the stress and a return of the situation is to be expected. I place more faith into a qualified certified Masso-Therapist who relaxes that muscle Whether sitting, back strap use, bar stool, or drum throne, you must be in good condition prior to the work. Before playing, whether practicing or session, do the stretching exercises. I remember a time when Natoli was videoing me doing exercises during an accordion trio rehearsal in a local union hall. Everyone thought it was amusing, but.....

"But when you think of the weight and the pull on the spine and neck area from the straps, it's no wonder more people don't develop problems. Funny though, I enjoy playing so much that I never notice it during playing...only after."

That's an area of mine that is bothersome to this day. After 50 years of performances and standing those four hour jobs, sometimes two jobs back-to-back, my week spot is Cervical 5-6-7....for those unaware of that area, it's in the lower neck about shoulder high. I attribute that to the accordion these many years, and it started ........when, for illness, I quit exercising, and it did the damage, never to heal. Docs say to live with it.

From: Joe Natoli -- jnatoli@sygnet.com

Wim's story is most touching because he has hit on the real problem with accordion playing. He and many others have the same problem that I do and it is much too coincidental to dismiss. Although Steve Navoysky's and Bob Berta's comments on back exercises are much appreciated, I notice that even Steve has the same problems with the same cervical areas in his neck (despite his back exercises).

My belief is that after years and countless hours of practicing with such a heavy instrument, the tugging and pulling on the back and neck muscles is not well-tolerated by most people's bodies. When one is young it doesn't seem to be so much of a problem, but as one ages, the manifestation becomes much more noticeable.

The end result is a compression of the 5th and 6th cervical areas of the neck which over time will result in spondylosis (that is arthritis). Spondylosis in the neck (which I have by the way and sounds to be Wim's and Steve's problem too) will lead to numbness and tingling sensation in the hands (especially while playing). In fact, that is why I try to produce CDs at home now, because a concert career is and has been out of the question for me.

Every time I practice, especially difficult works, I have to stop at about the 1 hour mark, because my hands start to fall asleep so badly that I can't even feel the keys anymore. This occurs even more so with the left hand, but also occurs with the right hand as well. And just like Wim, it never occurs with piano or any other activity I pursue except the accordion. Therefore, in my estimation, the instrument definitely has its drawbacks for those who are succeptible to this affliction.

God bless and continued good health to those who were lucky enough to avoid this malady. But to those who do have the problem, you definitely have my empathy.

From: "Senen Racki [Ontario]" -- Senen.Racki@ec.gc.ca

I play a Giulietti free bass converter (very heavy) and recently bought some new straps from House of Musical Traditions. I opted for the "elephant" model with lots of padding and an integrated back strap. At first I really hated it because it totally changed my playing position. After a few practice sessions it was a natural feeling. Now it bothers me very much when I DON'T hook up the back strap.

I'm 28 years old and have had back problems for 3 years now. I asked my chiropractor about my accordion playing specifically and his response was that it's not the instruments fault, it's mine. I've gained 40 pounds in the last 4 years and my physical activity has dropped a lot. As a result my back muscles have weakened and the extra body weight has stressed my back. The addition of the instrument just exceeds the threshold that my back is able to put up with. So, not wanting to give up playing, I've began doing some simple exercises and it's helped a lot.

From experience, my recommendations for anyone not wanting to change instruments is to invest in a really good set of straps which either have a back strap or can support an add-on back strap, see a chiropractor to get advise on exercises to strengthen the back muscles, and finally, break those long practice sessions into smaller ones with physical activities (like walking) between.

Senen.

From: Toni -- clark@salus.med.uvm.edu

I've been working for over 14 years at an engineering research center on low back pain. Bob Berta's well-informed advice is excellent. It's interesting that the old advice to "lift with your knees, not with your back" has never been validated scientifically. But some things we do know about lifting. Among them, the most important are to keep the load as close as possible to your body (don't lift with a long reach), avoid bending and twisting while lifting (that causes a lot of injuries from snow-shoveling), and perhaps most important, to think before you lift, in order to anticipate the load. As for playing an accordion, it seems that a back strap can go a long way toward reducing back pain. If that doesn't work, a rehabilitation engineer might be able to devise a belt of some sort that would transfer the weight from your back to your pelvis. (Not a standard back-belt, though; not much evidence that they have any physiological effect-- though many workers like them and say they feel better wearing one. Who knows?)

A couple of years I surveyed this group (or the group online at the time) about back pain among accordionists. Quite a few replied, the experiences and solutions about as varied as the respondents.

From: snav88@aol.com (SNAV88)

I enjoyed Berta's response. Heed it well and copy it for you'll benefit greatly. The copy-paste portion above is very important however. Proper height chairs, stools, etc are only a SMALL part of it.

Remember: Learn to sit correctly and maintain that posture. I do not advise a chair as it has a back to it and the tendency is to relax and lean against the back. Sit up straight! and closer to the front of the chair. I've used a bar stool for years and found this productive. Drum thrones are very good as well as you can raise them to the critical height for YOU!. I use those at times as well as I can adjust them to a half-sit, half-stand position.

(Cartoon from The History of the Accordion in New Zealand by Wallace Liggett.)

From: Lorna -- accordiannna@aol.com

I am completely in the "must use a backstrap" camp. If I take one of my instruments somewhere, and find that I have forgotten my backstrap, I will improvise (I've used rope, a dishtowel, and my purse strap in the past) rather than play without the back strap.

With the strap, there is virtually no stress on my shoulders or upper back. I am a average-sized woman with smallish shoulders but nice solid hip bones. What the strap does is transfer the weight of the accordion from my shoulders to my hips. This works much better, whether standing or sitting.

I should mention that what I *did* manage to damage with the accordion was my left hip, from carrying the case in my right hand all the time. Another accordionist once told me that a chiropractor had advised her to carry the case in her arms in order to balance the load. This looks silly, but avoids twisting the spine, hips, etc.

From: Dan Plestid -- dplestid@interlog.com

I love to play standing. I find it helps to move around a bit though if playing for long periods and to remember to take a break or sit down to play for a few minutes before my back feels strained. Once I can feel it I know I'm confined to sitting (and possibly the next day too). One of the worst things you can do is lift with your shoulders out of square to your hips. To prevent daily deep lifts of any nature I store the accordion on top of a five foot high file cabinet so I don't have to bend to lug it out of the case. I am six feet tall so this puts it at shoulder height giving me a stable lift down. I then rest a foot on a chair and rest the accordion on the raised knee to put the straps on.

Some of the responses mention back exercises and there was even an offer to share a regimen. While for an otherwise healthy back the exercises might help and would probably not cause harm, in some cases they can.

I have had back problems most of my life. On one occasion about eight years ago I had just moved and went to see a local doctor who prescribed an anti-inflammatory and an exercise program to follow after the prescription. This consisted of a printed sheet of 10 exercises. The prescription didn't help and weeks later when my back was feeling better I started the exercises for prevention -- my back got progressively worse and I stopped them. Three years later my back was in bad shape and I went to my new family doctor. She imparted her own tips on back care and then pulled out the same exercise sheet the other doctor had. The first thing she did was cross out the last four on the sheet as she said they would aggravate my particular problem.

The remaining exercises have helped wonderfully and if my back starts up I return to them instead of a doctor -- but I would recommend anyone starting new exercises to see their doctor first -- and get a second opinion if they don't work.

From: Gregory A. Vozar -- gregvoz1@pacbell.net

I see that this is a common problem for lots of accordionists. Some of the people that responded are not players of big instruments either. In addition to the herniated disks and muscle spasms, I also seem to have fibromyelitis, a condition where muscles get hard and knotted when worked rather than becoming more pliant and flexible. I spend about one hour daily doing elaborate stretching exercises. Without them, I probably could not function physically (even with them it is difficult). Working out in even the mildest fashion has only caused me MORE pain! Right now, I'm an absolute wimp because of this.

I took out my little chromatic last night and had to put it away in ten minutes because I felt the lower back muscles tightening up. To have done more would have left me in misery today. I even wonder about the bandoneon as my wrists have given me problems as well. I wear braces to bed to keep me from bending them in my sleep. I used to wake with numbness & pain in my hands. Years of computers, keeping a voluminous journal and writing letters has also taken a toll. I had to give up what started out as a successful venture in American Sign Language for the same reason.

From: Guysqueeze@aol.com

Subject: accordion pain in the back?

Regarding accordionists and back pain: in my experience, lower back pain is caused more by the lifting and carrying of the accordion in its case than by the actual act of playing the instrument.

I had chronic lower back pain for years, but I took two steps which have had a tremendously positive impact on my health: 1) I traded my sedan in for a station wagon so that I would have a flat load-in, rather than having to constantly lift the instrument up and out of a trunk compartment; 2) I purchased a soft pack (with shoulder straps) to carry the accordion in for all engagements involving stairs--thus cutting the weight from 50 pounds, for instrument+case+wheels, down to 30 pounds for accordion+soft pack.

For plane travel, I purchased a hard-shell-oversize Samsonite suitcase which I have lined with bubble wrap top-and-bottom and styrofoam on the sides; I put the accordion in it's soft case, and put that inside the Samsonite. That way, when I get to the other end, I can leave my suitcase in the hotel and travel back and forth to the venue with just the soft pack.

One factor that may be different for me is that, being a concert performer who plays a 30 pound instrument, I sit when I perform. Thus my advice does not take into account those players who have to stand when they play.

I hope this helps.

Sincerely,

Guy Klucevsek

Francis Brault

fgrault@worldnet.att.net

Date: 1998/10/20

I have a small button accordion. Since starting to learn to play it I find that I'm getting a lot of numbness in my left hand. This seems to be caused by the pressure on the back of the hand from the strap, when pulling. Any thoughts on how to play the accordion and avoid the "damage" to my left hand.?

Jeroen Nijhof

J.H.B.Nijhof@aston.ac.uk

Can you adjust the strap? Probably not, but if you can, you could try extending it. You can on most piano accordions: there is a wheel on the top of the bass side, with which you adjust the strap.

Do you bend your wrist too far, perhaps? (I am just guessing here)

Art Bailey

zapbailey@aol.com

I had to put down my acc for a month due to pulling muscles in my left wrist. Fortunately it healed with rest and the use of a splint. One aspect of my lack of technique that was pointed out to me by another accordionist was the fact that I was trying to play the accordion like a piano (I am a pianist) by hitting the keys, when in fact all you need to do is press gently with no force. I don't know anything about button accordion, but in teaching myself many instruments and always encountering new muscles that I didn't know I had, check thoroughly your posture, how you hold the instrument, the angles of your arms to your body, what muscles are being used, etc. Also, note the posture and technique of another experienced button player if you can. Take some lessons. Numbness in the hands is *very* bad and not to be taken lightly- when you feel any kind of soreness from playing, put the damn thing down! Also, I always stretch before playing, and massage my forearms, wrists and hands often when taking breaks. Good luck-