Ouch?  No!!  Try: Pain Prevention!

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Endorsements    General Questions    Hammered Dulcimer Questions    Autoharp Questions

This page was released into Cyberspace on Tuesday, June 20, 2006 at 5:10pm MST  and was last updated on April 28, 2008 .

        If you are experiencing discomfort, pain or a confirmed injury as a result of playing hammered dulcimer or autoharp (or another instrument) and are coming here for more information, or if you just want to be sure music-related injury never becomes part of your life, or you're a therapist looking for ways to help an injured patient: Welcome!
        Bear in mind that I am not a doctor, but a classically trained musician who has been studying dulcimer- and autoharp-related injuries since 1985 in order to provide information, encouragement and hope to those in need of healing.[1]  While it's certainly possible to heal yourself by revising the "how" of your habits, it is always wise to consult a medical professional knowledgeable in Repetitive Strain Injury (RSI), Carpal Tunnel Syndrome (CTS) and related upper-body conditions should you have any doubt, or if your symptoms don't go away.  (Remember: These conditions are not in your head, and are not necessarily induced by hereditary.)  Music-related injuries do not have to be permanent, debilitating conditions, and most of the time players can heal themselves through observing the habits behind them and then embarking on retraining.  And when healthy habits take over, tone and musicality both improve!
        If you are a doctor, therapist, dulcimer/autoharp teacher or an injured dulcimer player/autoharpist/musician in need of more support beyond what follows (which is just scratching the surface), allow pop-ups on this page if you have to, then feel free to .  I invite you to visit here often; this page is updated as more information becomes available.

        Note: Much of the dulcimer information here was presented at the 24th Annual Symposium of the Performing Arts Medicine Association on June 24, 2006,
and enthusiastically received by doctors, therapists and arts professionals alike.

Endorsements

        I had the privilege to attend the presentation given by Lucille Reilly, titled “Beyond Diagnosis: Retraining the Hammered Dulcimer Player,” at the 24^th Annual Symposium on Medical Problems of Musicians and Dancers in Aspen, Colorado June 22-25, 2006 .  I was extremely impressed with Ms. Reilly’s analysis of the biomechanics, anatomy, and alignment that is necessary for the dulcimer player to safely and effectively play the instrument.  She demonstrated beautifully what happens to the trunk, and the upper and lower extremities, if both the instrument and the player’s body are not properly positioned.  Her understanding of what is necessary, both from the anatomical and ergonomic perspectives as they relate to the playing of this instrument, is outstanding.
                --Michelina C. Cassella, PT; Director, Department of Physical Therapy and Occupational Therapy Services, Children's Hospital, Boston, Massachusetts USA

        Lucille’s conclusions are consistent with my long-term personal study of soft-tissue and neural-muscular injury (I suffered serious non-music-related accidents in 1990 and 1998). Her insights and discernment have boosted my musicality on hammered dulcimer, brought me greater expressive freedom with the dulcimer and other instruments, and aided my general recovery as well.     –Scott Reeder, hammered dulcimer player, “Music for All Seasons”, New Mexico USA

        Thanks, Lucille.  This is good stuff.    
                --Kathy Durant, dulcimer player/teacher, Maryland USA

General Questions

I've heard that feeling some pain when practicing is a good thing.  Isn't pain a sign that I am improving?

Will drugs heal a music-related injury?

What about stretching exercises, massage, acupuncture?

What about surgery?

What's involved in retraining?

Have you ever needed retraining from injury?

Where can I get more information on RSI and retraining?

Hammered Dulcimer Questions

What are the likely causes and effects of hammered dulcimer-related injuries?

What are some tangible things a hammered dulcimer player can do to play freely?

What is the best height and tilt for my dulcimer?

I was told to play with my wrists.  Is this okay?

How do I know when my wrists are in neutral?

Is it better to stand or sit when playing?

Should I wear wrist splints while playing the dulcimer to avoid bending my wrists to strike the strings?

I've been holding my hammers "out of whack", according to this page, for a long time, and I don't feel any pain.  What's so bad about the "pinch grip"?  It seems like every player I know is using it!

I have arthritis in the joints of my fingers.  Should I still attempt these neutral principles of holding the hammers and striking the strings as you advise, or am I on my own?

Autoharp Questions

What are the likely causes and effects of autoharp-related injuries?

What are some tangible things I can do to avoid injury when playing the autoharp?

Is it better to stand or sit when playing?

It sounds like neutral wrists are essential.  How do I find neutral wrists?

I've been taught  to strum by not pushing my thumb across the strings with my arm, because it's said that will hurt me.  What do you have to say about this?

General Questions

I've heard that feeling some pain when practicing is a good thing.  Isn't pain a sign that I am improving?

        No.  If you think you have to hurt, even a little, in order to make progress, think again.  Pain means there's a problem with how you're playing (biomechanics) or the instrument's physical set-up in relation to your body (ergonomics) or both.  If you can't troubleshoot what you are doing to identify the source of the pain, get a consultation from a medical professional.  After this, I would seek out a musician who understands the importance of retraining to reverse these kinds of injuries (better yet if that person is a dulcimer or an autoharp player).  Some retraining resources include a certified Alexander Technique teacher, and the organization I am training with, Andover Educators.
        When you experience pain while playing, your sixth sense, kinesthesia or the feel of playing, is talking to you--except that's not the kind of talk you want.  When the movement you use in playing feels spacious, buoyant, free and without pain, your kinesthesia tells you that all is well.  And when it does, listen to your instrument!  You'll most likely hear it sing and resonate in wonderful ways that it wasn't allowed to do up to this point!
        Note: In my experience as a teacher and from observing random players at festivals and in the workshops I teach, dulcimer players especially exhibit so much tension that they cannot feel the chronic pain they live with every time they play.[28]  If you are unsure whether or not you are playing with excess, unnecessary tension, find someone who can help you assess.  If that someone also plays your instrument, that will be a huge help.

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Will drugs heal a music-related injury?

        No.  They will help you manage the pain, but will not heal what's causing the pain, and some of the side effects from them aren't pretty, either.  (One of my dulcimer friends asked me to supply a laundry list of side effects here, but if kidney/liver damage alone gets the point across, you can use your imagination from there.)[19]  Retraining in time will heal the injury and permanently relieve the pain.
        Some musicians have been directed to take non-steroidal anti-inflammatory drugs (NSAIDs), ibuprofen, etc.  If you go this route, please do so at bedtime or whenever you are not engaged in the activity causing the pain.  DO NOT take pain-relieving drugs before you set out to practice or perform!  When you're "on something" while playing, you won't feel any (or as much) pain, but it also means you also won't feel any additional damage you may be doing to the affected area(s) by continuing the habits that caused the injury in the first place!
        Some medical professionals I have spoken with recommend not taking drugs while retraining.  By avoiding drugs, you'll have the benefit of feeling the pain go away by which to chart your progress.  (This sounds strange, but diminishing pain will also make you a believer in the retraining you're doing.)
        Note: There are plenty of web pages on the Internet promoting drugs as the "cure".  Again, all drugs will do is manage your pain; they will not heal the injury!  Retraining is the solution most of the time to healing repetitive injuries.

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What about stretching exercises, massage, acupuncture, etc.?

        Exercising the affected area to improve circulation, lengthen muscles and promote healing will be beneficial as long as you have revised the habits responsible for the pain!  If you are still playing with injurious habits, any positive effects gained from stretching, etc. will be negated once you resume playing. Ditto for massage, acupuncture and other treatments: These procedures feel great, but persistent, tension-laden habits in one's normal activities, including music making, will undo all of that good feeling and put you right back where you started, in pain.
        By the way, because my entire body is in neutral whenever I play, I don't worry about taking "loosening measures" like shaking out my arms after playing the dulcimer in particular.  The way I hammer, I shake out continually as the music happens!  That's why I can walk away feeling exhilarated after jamming for two hours or more.

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What about surgery?

        While extreme cases of RSI/CTS may require surgery, many times a change in playing habits and the instrument's set-up will restore an injured player's body to balance.  Note that the internal scarring that comes from surgery may get in the way of free playing afterwards.[21]
        Following a dulcimer workshop I taught in 2005 (where I uttered one statement about steering everyone away from injury), one of the attendees approached me afterwards to say that she'd developed Carpal Tunnel Syndrome from playing the piano, gotten surgery for it, and that CTS came back shortly after she resumed playing piano again.  She told me she then started retraining, and now she's healed from the recurrence at the piano.  She was grateful for the ergonomic approach to dulcimer playing presented during the workshop.

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What's involved in retraining?

        Accepting that retraining is needed, and time.  (I've been there; read my story.)
        For many musicians, be they casual or serious about music-making, acceptance is the harder part.  I meet people all the time who just plain want to stick with familiar coping, no matter how much it hurts.  Excuses can run from "it's only a folk instrument" to "it'll go away" to "at my age?"  Attitudes towards folk instruments are particularly rife with being about rule-less playing (note that "you can play any way you want" is meant to define styles of music, rather than haphazard ergonomics and techniques).  However, when playing that folk instrument gives you pain, your body is telling you there are rules behind playing it, and it's time you found out what they are.  If you play a lot, or intend to, it would be an enormously good idea to observe what about your playing is the culprit behind the discomfort and then find out how to revise it.
        No doubt about it, retraining can be a long road.  Our society is into quick: "Gimee a drug, doc!" but it really is time that will heal the diligent (and you already know from this question that drugs can hinder the process).  And the benefit, always, to accepting both retraining and the time it takes is easier playing and improved sound.
        Some simple things you can do, with the help of a trained eye: 

• Take a good look at your current ergonomic set-up.  Ergonomics (something that's now finally buzzing around the dulcimer community, and has been around the autoharp community for a while) is a good start, but there's more.  Keep reading:
• Observe your biomechanics (a mirror is the cheapest video camera around.  It's hard to say which I see more: out-of-balance playing approaches (especially to the dulcimer) or ergonomics gone awry.  But, no matter.  Both need attention if you want to avoid or beat RSI.
          A case in point: In another city, I gave a private dulcimer lesson to a left-handed player who expressed concern about pain in her right shoulder while playing.  She played "The Irish Washerwoman," striking the first measure LRR LRR.  Knowing that the dual right-hand strokes were making her eek out the second R in each LRR, thus causing her shoulder pain, I took her through a series of short exercises leading up to the playing of that measure using LRL RLR, thus giving both hands enough strike time and get her forearms moving.  Once her stroke order was revised, she played the entire tune LRL RLR, but was still playing with her wrists.  Her reason for wristing: Her dulcimer was high in relation to her arms.  We looked at her personal "rest distance" between hammers and strings, and by it set a workable dulcimer height.[6]  Her dulcimer needed to be lowered three inches!  Amazingly, the lower height automatically enabled her elbows to open and close, allowing her forearms to manage the hammers' striking the strings instead of force-bending her wrists.  Not only did these changes completely cancel her shoulder pain, but her dulcimer also sang in new, resonant ways.
          This is just one example of how retraining can work to a player's benefit.  The specifics, of course, will be different for each individual towards the instrument being played.

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Have you ever needed retraining from injury?

        Not from playing the dulcimer.  I've been playing a lot and fast since my first strike in 1978 with nary a problem.  Many, many times I am the sole melody instrumentalist in a contra-dance band of only two people.  After playing nonstop for three hours (clocking in at roughly 339.5 notes per minute), I not only leave the dance feeling fine, I also feel fine in the days following.  In 2004, a masseur sitting in the front row at one of my concerts told me afterwards that he looked for signs of wear and tear in my body while I played and couldn't find any.  Something's working.
        However, the computer has tried to defeat me.  Twice.  I share my experiences here in hopes that injured music makers will draw some parallels healing from a music-related injury.

        The first incident, a minor one, occurred in August 2000 while working in Yellowstone National Park.  As relief night clerk at the Old Faithful Inn, a job requiring a fair amount of typing, a tingling in my fingers crept in during a night shift after four months on the job.  Admittedly I became a little frantic, not knowing what this might also mean for my music making.  I began troubleshooting, found the problem, then called home to have my clogs, with heels about 2 inches high, shipped immediately.  (I had decided against bringing my clogs to Yellowstone because running was impossible in the event of a fire call in the Inn.)  It turns out that the platforms in the front desk for the computer keyboards were set too high for my short frame, and because they weren't adjustable, the only way I could improve the ergonomics was to raise myself.  (Can you believe that the front desk was completely remodeled in 2006, without including adjustable keyboard platforms?)  The clogs were just the ticket, and the tingling diminish over the next few days as I continued to on the job.  Lesson learned.

        The second incident was larger and more mysterious.  Early in 2005, I felt a pain slowly creeping in at the front of my left shoulder.  I thought it was a bike injury from 1987 returning to haunt, as I had heard that pain can revisit us as we age.  As 2005 progressed, the pain gradually increased.  I was beginning to wonder if surgery was in my future, not a happy thought.
        That June, while taking a course in Body Mapping and Alexander Technique at Westminster Choir College, the cause of my pain came to the fore while one of the students in the class received a piano lesson in front of the rest of us in order to troubleshoot an identical pain in the front of her right shoulder.  When her lesson was over and the class took a short break, I went running to the first computer keyboard I could find.  I held down Ctrl-C with the pinky and index finger of my left hand.  The pain poured on.  It turns out that the bike injury had nothing to do with the pain.  Instead, I was injuring my shoulder area from executing some much-used keystroke commands repeatedly caused by chronic ulnar deviation at the wrist!  (My left wrist felt fine, by the way.)  I had begun using keystroke commands a few years before, partly to protect my right hand from using the mouse a lot, so this developing injury, on my left side, was a complete surprise.  As my laptop had been along on this trip, that very afternoon, I began retraining my hands to type keystroke commands with the fingers of both hands.
       But, easier said than done!  I'd taught myself in a snap how to copy, paste, cut, etc. with just my left hand (how clever I thought I was to come up with that shortcut--wrong!), but retraining to type commands using two hands was s-l-o-w.  Every time I caught myself heading for a one-handed command, I stopped and rethought a two-handed approach.  Getting anything done on the computer that first day, and for the first three weeks, felt like it took forever.  However, after those first three weeks, both hands began working together with less conscious effort, though I still had to (and sometimes still have to) think a little before keying.  But yes, the two-handed commands did come more automatically in the days and weeks following, and four months later--yes, FOUR MONTHS--the pain was gone.
        Did I like changing those commands from one to two hands?  No.  Did I have to do it?  Yes, if I didn't want to spend the rest of my life in pain, stop typing, stop making music, or--I don't even want to think about "or".  Did I take drugs?  No, there was no need, and I got to feel the pain go away.  Did I see a doctor when I got home from the body mapping class?  No.  I went on the confidence of what my mentor, Barbara Conable, said: that the pain was due to the synovial fluid around the tendons disappearing due to constant abrasion, and that the fluid would once again lubricate the tendons as the injury healed.  There was no sense going to a doctor to get needless X-rays for something he or she might not be able to detect.  If I already knew the cause of the pain and what it would take to reverse it, what more could a doctor have done?  (Note: Perhaps this case was a mild one, permitting me to work things out on my own.  Those who believe they are in really bad shape may do well to get a medical consultation, definitely from a doctor well-versed in repetitive and performance-related injury who will encourage retraining and save surgery as a last resort.  Healing yourself is always worth investigating, and a medical professional who understands retraining will be gold to you.)

        As I can attest, change is hard when what we already do feels familiar, even if it may be potentially injurious.  We don't want our music performance to fall apart, even for a moment, due to going through the process of change.  It's easy to think about everything we are going to lose, but the glass is half full: I prefer to think instead about what I stand to gain as a result of healthy changes in the tasks I perform most.  Why would anyone not want to trade the inferior familiar for the superior spectacular?

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Where can I get more information about RSI and retraining?

        In addition to private and "B&B" lessons, I teach classes about the body in hammered dulcimer workshops; click here for more information.  
        The following books and web sites will tell you much more, as well as encourage you:

Conable, Barbara, What Every Musician Needs to Know about the Body, Andover Press, Portland OR, www.bodymap.org, 2000.  An easy, informative read, lavishly illustrated and with good humor.

Conable, Barbara, and William Conable, How to Learn the Alexander Technique, Andover Press, Portland OR, www.bodymap.org, 1995.  An in-depth version of What Every Musician..., above.

Pascarelli, Emil, Dr. Pascarelli’s Complete Guide to Repetitive Strain Injury, John Wiley and Sons, Inc., Hoboken NJ, www.wiley.com, 2004.  Dr. Pascarelli knows more about this subject than anyone else.  While much of it deals with computer use (also good for us dulcimer players to know about) he does address musicians, too.

Reilly, Lucille, Striking Out and Winning! A music-maker’s guide to the hammered dulcimer (2nd edition), Shadrach Productions, Denver Colorado, 1992.  The hammer hold and striking techniques were put to the test in 2005 and passed.  You won't find a  more complete source anywhere else to help the hammered dulcimer player play freely.

www.bodymap.org has some great articles about the effects of body mapping in music performance, and will take you to still other links.

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Hammered Dulcimer Questions

What are the likely causes of hammered dulcimer-related injuries?

        It is difficult to say exactly what is behind discomfort and injury, because so many issues can contribute to it.  Based on what injured players have presented to me over the years and my own studies to better understand the causes (and head them off at the students' pass), consider these possibilities:

The dulcimer tilts steeply.  Since the 1990s, dulcimer tilts have steepened sharply, up to 70 degrees!  (Contrast this with my 8-degree tilt, which in 1978 was considered radical in the midst of 0-degree tilt on stands!)  I wanted to learn more about tilt, in June 2006 I performed a study on stand tilts/heights to learn about their effects on playing and overall sound.  When I played at a 40-degree tilt, where increasing numbers of players set up nowadays, great pain poured onto my upper body after only ten seconds of playing, and I experienced a sensation of choking.  No matter how I adjusted hammer hold, playing action, etc., to make peace with my body, the pain would not go away while I played and in fact locked itself in for days afterward.  Do steep-angle players not feel pain?  I would like to know!
        Additionally, I found that the steep angle made the strings harder to see!
        Well, I invite you to test tilt for yourself and   with your experiences.
        For specifics about dulcimer tilt, click here.

The vertical length of the dulcimer is longer than the the player's E-SP.  Players who fit these circumstances tend to place emphasis on striking the high strings only.  Therefore, an extended-range (E-R) dulcimer is usually tilted more to make the high strings easy to reach.  However, the resulting steeper tilt usually sets the bass strings low to the arms, making them out of the way enough to be uncomfortable to strike (which may be why players don't also wish to focus on the low strings).
        Perhaps another reason for steep tilt is subliminal: Could it be that players want to avoid bodily contact with the dulcimer when striking the high strings?  I worked with someone who decided to avoid contact, which in turn was also contributing to what she called "dulcimer elbow".
        I still recommend that E-R dulcimers be set up to the same free-range angles unearthed in my height-tilt study, as described here.  Players of vertically long dulcimers will do well to consider leaning towards, and quite possible against, the near side of the dulcimer's frame to strike the high strings.  Leaning means a slight, forward contact, not a hard lean where the player's body weight bears down on the dulcimer and stand.  A rock-solid stand is essential for the player who must occasionally lean against his/her dulcimer to strike the high strings.
        See this FAQ about E-R dulcimers for more information, especially if you are considering purchase.

An extended-range dulcimer with a course spacing of 3/4 inches or less (measuring from top string of one treble course to the top string of a neighboring treble course).  The suggestion to avoid close course spacing comes from the occupational therapist of an injured dulcimer player.  Let's take a look.
        With the pitch range of dulcimers becoming larger, some builders are retaining the size of existing dulcimer frames but reducing the space between courses in order to add more strings.  This configuration accommodates short players desiring a wide pitch range, but now consider this: Playing up and down the strings, and perhaps even across, requires smaller moves, which may make the player feel "crunched", instead of open and free.  Player height may further contribute to this equation: tall player = long bones = smaller playing moves than a short player.
        Until I can test dulcimers of shorter course spacings especially, it seems like 7/8" is the minimum spacing to consider, with 1"-1 1/4" being more amenable to movement.  I anticipate that a tall person will find wider spacing to feel easier because of the long-bones equation just mentioned.  There is no hard and fast rule here; it boils down to whatever helps the player's movements feel free rather than "scrunched" or "enclosed".  
        An engineering friend who does not play the dulcimer posed this thought when I discussed course spacing with him:  Imagine taking course spacing to extremes.  What would it feel like to play a dulcimer whose treble courses were spaced 3 inches apart?  Or a dulcimer whose courses were spaced a half inch apart?  Pretend to play any tune you know well on "air dulcimers" having these spacings.  You may quickly understand the importance of course spacing being a good fit for the music you play as well as for you.
        As dulcimer pitch ranges grow, I ask myself if the community at large is asking the dulcimer to be more than what is practical or safe for it to be.  Is the mousetrap being overbuilt?

Playing "square".  I have noticed, both at home and in the field, a universal tendency to hold the hammers perpendicular to the strings.  Right angles are part of the box that everyone wants to think outside of.  (Go figure!)  "Squaring" forces dulcimer players to contort themselves while playing, in observance of a rule that makes no sense.
        Introducing going outside the box: Let the angled sides of the dulcimer clue you in on your physical approach to your dulcimer.  When you can run a straight line through your forearms and hammers, the hammers become natural extensions of the arms, free to strike any string, high or low.  Let your forearms and hammers naturally "pigeon-toe" towards each other.  There is no appreciable affect on the sound whether the hammer strikes a course perpendicular or at an angle, so strike with the hammers at an angle.

"Unschooled" hammer hold.  Holding the hammers "any way that's comfortable" can have dire consequences: One player suffered almost permanent nerve damage, which thankfully he reversed to almost complete healing some three years later as a result of this verbatim instruction from his teacher.  (What was I saying above about time?)  This demonstrates how much the body can be thrown off when research or benefit of experience from teacher to student is lacking, or when the new player charges in without guidance around the known pitfalls.

Holding the hammers with the tips of the digits.  (Often resulting in squaring.)  Some of you reading this know that I have been studying hammer hold passionately for a long time.  As of May 2007: The closer the hammer handle sits to the digit tips, the further the arm structure goes out of alignment.  Why?  Because the hammers are destined to approach to the strings at the same angle, no matter how the hammers are held, or what the relationship of the player to the dulcimer is.  The body adjusts to accommodate the hammers.  When bodily contortion occurs, the player can experience discomfort or pain.
        While various players have expressed to me the "comfort" of the pinch grip, it is far from free: When the hammer sits on the ends of the digits, the player will hold on to it for dear life to keep from dropping it!  Which means the pinch grip is familiar rather than comfortable!  Think about this!  Without a means of comparison, there is no way of knowing what an easy hold feels like.  This story will tell you more about the importance of comparison.

The hammers!  The "traditional" hammer handles, which are curved on both top and bottom, not only tell many players to hold them with the tips of the digits; they may also suggest that the digits alone produce the strike action.  Again, arm joints (well, body joints all over) cease to be available to move.  (By the way, when I began playing in 1978, hammers in the US generally didn't have handles at all.)
        Flexibility is key, for both playing ease and resonance.  It was big news to me when I discovered how minutely all the joints of my hands move to execute rolls, single strikes, dynamic range, etc.  Movement is more than about the hammers and arms going up and down.  It is also about the continual adjustments the hands make for the sake of nuance.
        I recommend a single-sided hammer (having only one strike surface) click here to see a photograph.  To order hammers like the one shown in the photo click here.

Playing while standing or sitting still.  One dulcimer player developed DeQuervain's Tenosynovitis after six months of playing by freezing a severely bent and hitchhiked (hyperlaxed) thumb atop an upward-curved hammer handle, then "pistol-gripping" the bottom of the handle with the fingers to make the hammers go up and down.  (Worse, she was told the injury stemmed from how she had held babies 20 years before.  Huh?)  Still other players freeze their arms and move the hammers up and down from the wrists only (click here for my thoughts on wrist playing).
        We are lucky that the dulcimer can be readily played via the big joints.  This is freeing to the body, and to the dulcimer's sound.  I am often approached by onlookers about how much work I must be putting into my playing because I play with my whole body.  I tell them that what they're seeing is easier playing than I would produce by barely moving.  Contrary to what some believe, playing with whole-body movement is not excessive work, nor is it banging!  In fact, the more the body engages in the playing, the better able the hammers are to rebound off the strings on their own, giving just the right amount of strike with less force and more resonance.  Why not have it all?

"Anything goes" stroke order.  This shouldn't have to be an issue, but the stop-and-go that usually lives alternating strokes all the time or "just making do" can be enough to cultivate discomfort, unless continuity is thought out very well and purposely sought.  This kind of stroke order often comes with a limited and/or "horizontal" outlook towards the dulcimer's tuning scheme.  Players often have a goal to play horizontally across the soundboard, a technical detail that is desirous when practical.  Horizontal and vertical approaches have no appreciable effect on musicality, although they can have considerable effect on ease of playing and seeing one's way around the strings.  It is important to be flexible enough to incorporate horizontal or vertical as needed, as the dulcimer's unison courses guide us, rather than to strive for one approach or the other exclusively.  See a FAQ for more by clicking here.
        I use a rhythm-based stroke order when I play.  This is detailed in full in Chapter 4 of Striking Out and Winning!  This stroke order, whose downbeats are consistently struck by the dominant hand, allows for fluid, free movement between strikes and precise, rhythmic playing.

Buying into "free lunch".  Let's put the adage "you can play the dulcimer any way you want" into perspective.  This is true, musically speaking: I freely improvise and extemporize the music I play any way I want.  But there is no free lunch: I cannot set up the dulcimer, hold the hammers, strike the strings, etc., any way I want as well.  To do so comes with risk, as the injured folks whose bits and pieces you have read about here have already demonstrated in numerous ways[7].  Try as I might, I cannot boil a pot of water by putting it in the refrigerator.  And so it is with "free-lunch" dulcimer playing: Some wonderful players have had to reduce the amount of playing they do, or stop altogether, with a few ending promising careers, all because they embraced a free-form, ergonomic and/or biomechanical approach.

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What are some tangible things a hammered dulcimer player can do to play freely?

Balance your body to achieve full stature and ultimate freedom.**  The Alexander Technique advocates, "The head leads, the body follows."  Which way does the head lead?  UP, not forward!

Cultivate an accurate body map in order to understand how your body is designed to function, then work with it, not against it.**   This doesn't require taking an anatomy or physiology class; there are some good books out there to help you get on the page.  
        Some common body-mapping errors of dulcimer players are:

1)  Bending at the waist--The fashion industry gave us waists; the skeletal structure, alas, does not include one.  We bend at the hips, just in case you wondered.  Try it and see!.
2)  Muscles in the fingers and thumb--The digits do not have muscles, only tendons.  Fine-motor coordination comes from the large muscles of the arm.
3)  Joints of the arm structure--Most folks know there about three, but there are really four!  The first arm joint is the sterno-calvicular joint.  (Trust me, it looks really weird to watch someone make music without this joint!)
4)  Joints of the fingers and thumb--how many are there?  You'll use them according to what your answer is!
4)  Arm organization through the thumb--the arm organizes through little finger, as mentioned below in hammer hold.
5)  Short arms--Now that you know where the first joint of the arm is, you can see that your arms are much longer than you thought!  Remember: If you believe your arms are short, it is possible that you will use them like they are short.
6)  "Relaxed" shoulders--These often translate into shoulders being at their lowest possible point, limiting mobility of the arm structure and creating finger tingles and shoulder pain.

Understand where the music comes from: Music is a 75-25 proposition, with 75% comes from the player.  Because we make the music, we must move to make it!  Neither the dulcimer nor the hammers can produce sound without the player's help.

Know that stands and hammers can be the biggest culprits behind discomfort.  There is no way to achieve neutrality in the body when poorly designed accessories won't allow it.  Unfortunately, I am hearing more and more horror stories about physical/occupational therapists who don't know that dulcimer accessories may well be central to a player's injury, possibly because they have never seen a dulcimer up close, nor are they aware of the global range of differences in stands and hammers.  As a result, some wonderfully knowledgeable professionals are molding bodies around inanimate objects, instead of the other way around.  (More about stands and hammer design in the next three entries below.)

Use a stand that's fully adjustable in both tilt and height, and set both where YOU need them.  Just because the stand can produce a large range of tilts doesn't mean that all tilts are advantageous, safe or usable.  Fully adjustable stands need the long slots so that tall players can set up the dulcimer to suitable height.
        No matter what the tilt and height, the hammers are always going to orient at the same relationship to the dulcimer.  For this to happen, the body will adjust itself.  Our goal is to ensure that those adjustments are for the benefit of both the body and the music.
        Remember your shoes: Your height will change when your shoe height differs at practice vs. at a gig.  You'll need to be able adjust the dulcimer's height to maintain the same relationship to the dulcimer when in dress shoes as when practicing with sneakers on your feet, or bare feet, at home.
        Also, because the dulcimer's angle is different for sitting and standing to play, a fully adjustable stand is a good investment.

The hammer handle, if there is one, needs to be flat on top and curved (or flat) on the bottom.  This design supports a neutral hammer hold (see also next point).[23]  But buyer beware: Even some handles fitting this description confound the player when they are wide (meaning the width you see as you look down at the handles when holding them).  The best fit comes from a handle whose width is about half that of the middle phalanx (the area between the creases on the skin) of the straight index finger.
        Certain non-handled hammers can be fine, as long as they balance amicably in the hands.  I have some long ones in my collection that feel top-heavy and sluggish when the ends of the shafts land in the same place under my thumb as shown in the photo below.  But when I "choke up" more on the shafts to achieve a lively and agreeable balance, the end of the shaft lodges under my palm so that the hammer cannot swing up and down freely.  The shaft ends can always be trimmed shorter, but trimming also re-balances the hammers' center of gravity.  Saw at your own risk.
        Some upward-curved handles are okay as long as the curve is very slight; note that this produces a small loss of hammer flexibility when playing.  The key to a free hammer hold comes from the thumb aligning with the hammer shaft.  It's a good idea to hold the hammer and see if it lets your thumb align with the shaft.  If not, keep looking.
        (At the Original Dulcimer Players Club 2007 Funfest, I met a pair of double-sided hammers having handles that looked odd enough not to work but instead agreed amicably with the hands and fingers!  Unfortunately, the maker of those hammers isn't making them commercially.  Let's all hope he changes his mind!)

Establish a neutral hammer hold.  The neutral hammer hold sets the hammer between the creases on the index finger so the thumb can simply rest on top of and in line with the handle, as shown in the photo below.[15]  The handle shape allows the hammer to be held over the center of the hand, freeing all joints.  If you have never held your hammers like this before, expect it to feel different for a little while (if you play a lot, you'll ease into this quickly).  Hang in there, especially if you're an experienced player who is retraining.  
        The neutral hold sets both hand and wrist in a neutral rest relationship and allows the entire hand to hold and support the hammer.  This hold also allows all joints in the hand to flex in small increments to produce the various nuances within string striking for single strokes, rolls and the like.  Plus, a neutral hold encourages bending the elbows so that the forearms take the hammers down to and away from the strings, allowing players to take advantage of the large arm muscles (which, by the way, can be struck gently as well as firmly).  The result of a neutral hold is always flexibility with full-bodied resonance from the dulcimer.[1]  

"Pigeon-toe" the hammer tips towards each other.[24]  This is easy to do once a neutral hammer hold is in place.  See Chapter 2 of Striking Out and Winning! for the pictures.

The stand, both in height and angle, must allow the elbows to be open 90 degrees or slightly more before playing begins[20], something a free-range angle allows, as long as the dulcimer isn't too high for the player.[7]  You may wind up standing or sitting further from the dulcimer than you usually do to open your elbows this much, but look for the strings angling toward each other, as shown in the photo at right.  (I took this photo after playing in G major to establish my normal playing distance from the dulcimer; the photo shows exactly what I see with my dulcimer tilted to 8 degrees.  The bridge mark, barely visible in the center of the photo, identifies the G-D treble course.)
        When you see angling strings, you will be able to discern the treble from the bass strings.  If the strings look parallel, you are either too close to the dulcimer or its tilt is too steep. And one more thing: Don't jut your head forward to make up for your body being further away!  This will crook your neck as well as tighten it, which in turn will tense the rest of your body (remember: when you can't move, you can't play).[22]  Instead adjust your vision (angling strings will be a different look indeed), and if you must get your head closer, bend at the hips a little to bring it forward.

Bend the elbows to strike the strings via the forearms.  My wrists adjust as the hands/hammers go up and down, the same as shaking hands with a friend.  The wrists move passively, responding to the ever-changing positional relationship between hand and forearm as the hand goes up and down.[20]  The forearms move freely, not forcefully, and they don't have to move a lot.  As long as the hammers are free to "swing" up and down in response to the forearms, they will finish nicely what the forearms started, with substantial, easy contact on the strings and full, resonant sound.

Know all the ins and outs of the dulcimer's tuning layout.  Do you know how many visual patterns there are by which to play a one-octave major scale with alternating strokes throughout?  Most players know there are two or three, but there are more than this.  (See Striking Out and Winning! for the answer.)   Ditto for unisons and octaves, as well as adjusting stroke order to agree with the rhythm of the tune, not the dulcimer's tuning or the tune's pitches.[25]  The more you know, coupled with a rhythm-based stroke order (i.e., strong-hand lead, with the dominant hand striking all the downbeats in a reel, for example), the more you can move gracefully and in agreement with yourself while making music.

Be less obsessed with where a tune's notes are on the dulcimer.  Almost every time I ask a student to watch my arms or my body as I demonstrate an essential point of how the body moves to make music, his or her gaze usually heads for the strings instead.  Ah, the fear of not being able to play if we don't know what strings to strike!  (That's where practice and strike-pattern perception come in.  My hands move way too fast for anyone to see precisely where I'm striking, anyway, so watching the tips of the hammers is futile.)  Yes, we all want to play "right notes"--my students make gorgeous-sounding mistakes!--but let me say again how essential it is to know how to play yourself to find musical expression.

Allow your body's relationship to the dulcimer to change while playing.  Playing the high strings?  Move your body closer to the dulcimer by moving one foot forward.  Hanging around the bass strings for a while?  Move one foot back.   If you sit to play, lean forward or back from the hips, which means your back needs to be far from any back there may be on the chair.
        Playing a tune that's all to the left of the treble bridge?  Lean to the left and turn a bit to angle yourself to the dulcimer and face those strings!  Do your hammers have to sweep across the dulcimer to play a long arpeggio?  Sweep your body sideway to help those hammers along.  If you want to play all over your dulcimer (or if you're like me and have to), it is much harder to do under the auspices of playing "square" from one planted spot.
        And here is a surprise: Some dulcimers won't let the player face the strings squarely!  Treble bridges that are either dead vertical (90º) to the bottom edge of the soundboard or slanting slightly to the left can trouble a player's left shoulder area if the player sits or stands square to the dulcimer!  (I have a plastic T-square from my pre-computer publishing days that makes determining bridge angle quickly.)  Dulcimers having this kind of treble-bridge orientation tend to be shaped like irregular trapezoids, with the sides being different lengths and angles.  The good news is that players whose treble bridges are set vertically or slanting left can turn slightly to the left to give the left arm and shoulder area both breathing and movement room.

Move with your playing![10]  This is kinesthesia at its best, when you feel the joy within the spaciousness of free hammering from the first note to the last!  I don't know where the notion came from to remain as still as possible while hammering, but still playing means stiff playing, and that can be pain-producing.  When the arms stop in between strikes, playing feels like you are tapping your car brakes every 10 feet--it gets uncomfortable and tiring quickly, and it's a struggle to get where you're going.[5]  Nonstop to Toledo, please.  So, listen to your body--and your dulcimer!  The dulcimer is more than about those visual patterns we perceive on the strings, it's also about how we orient ourselves towards those patterns, too.  And when you move your body along with the series of patterns that comprise a tune, you'll be able to reach every strike point easily.  Movement has everything to do with musicality, ease of playing negotiating large leaps in a tune, etc.

Forget about "controlling" the hammers.  Every player I have met who believes they have to control the hammers plays with excessive, needless tension that makes them sound like they're slamming the poor dulcimer into the floor!  It takes far less effort to strike the strings when you let the hammers fall and rebound on their own as generated by the continuous momentum of the arms and body.  As I say in Striking Out and Winning!: You have to lose control to gain it.[20]  The hammers will know what to do when you let them.

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What is the best height and tilt for my dulcimer?

        This is a great question, because the best height and tilt for your dulcimer is indeed yours!  Dulcimer height is different for everyone, and here is a surprise about where it comes from: It is based not on the player's height, but rather on the measurement from the end of the elbow to the strike point (not the end) of the hammer (what I call E-SP).  Think about it: This makes a lot of sense, doesn't it?!  Further, know that the dulcimer's tilt affects its height: the smaller the tilt, the lower the dulcimer's height, and vice versa.
        In June 2006, I performed a study on dulcimer tilt, which included height.  I played the same scales and tunes all over the dulcimer, starting at 40 degrees and working my way down to minus-5 degrees, in 5-degree increments.  Dulcimer height was necessarily and gradually reduced with each new tilt.  Through all the playing, I listened to my body for comfort level (or lack thereof) and took copious notes throughout concerning feel (comfort vs. pain, with descriptions) and ease of playing.  The most comfortable "free-range" angles were these:

Standing to play: 8-15 degrees
Sitting to play: 20-25 degrees.  

        That's it!  Within this "free range," you can achieve neutrality throughout your body in order to play spaciously and easily for long periods of time (some of those jam sessions can be long, as you know, and you may want to stick them out without missing a note).
        It's easy to find a free-range tilt using an inclinometer purchased from the hardware store.  (I use mine all the time to set new students' dulcimers up; for one-time use, ask around the neighborhood to see who has one that you can borrow for a half hour.  Or set up your dulcimer in the hardware store....)  Steep tilts, especially 30+ degrees, make a neutral starting place for the hands impossible to establish and limit the core movement essential to musical music and a free feeling when playing.  They also situate the arms to oppose gravity while playing, reducing endurance and increasing the pain.  (Note that you may cut off blood circulation as well; um, do you really want to do that?)[7] 
        Once the tilt lands within range, the dulcimer's height is determined by the rest distance created by your E-SP, by bending your arms so both forearms and hammers are parallel to the floor, with the strike points held over a center course (often G at the bridge mark in first position).  Rest distance ensures that your arms have adequate space to take the hammers down to the strings.  I have set the rest distance for many players now with great results, eliminating guesswork about dulcimer set-up.  But now note this: Rest distance is not also a boundary defining how high the arms and hammers can go when they're on the rebound after striking.  Rest distance is nothing more than a set-up tool.  To learn more,   for a private lesson, or I'll be glad to come to your area to teach a workshop where a lot of players can have the benefit of setting up to feel and see the difference.  (Yes, see it, too.  Click here.)
        Remember: the lesser the tilt, the lower the stand.[6]  No matter what tilt you choose, the dulcimer's height will need adjustment as well.

I was told to play with my wrists.  Is this okay?

        You may already know from my books and elsewhere on this web site that I am a big fan of a playing action that comes from using the entire arm, rather than the wrist only.
        I have softened my thoughts about wrist playing in recent years, and realize now that it can be done safely, depending on how the wrists are used.  If the wrists take turns moving (what I call "rough wristing"), rather than simultaneously moving the hands up and down ("smooth wristing"), then the player will tire easily, with his playing reaching a tempo threshold.  Smooth wristing allows for faster playing, although the tempo threshold still remains lower than for forearm playing.[5--definitely look at this footnote; it's fascinating!]  I have seen players use smooth wristing and have to say in observing them overall that their bodies seem to be free.  I will understand more about this as my observation skills continue to develop.
        Now for my concerns about wrist playing:

• Wrist action invites halting movements when striking the strings, because the movements are necessarily smaller with only the hand going up and down.  This is particularly true in slow pieces.  Long notes need slow body movement between strikes.  When less of the body is engaged in the playing, the movements get less space to move in, making those movements necessarily smaller.  The time space is harder to fill completely within the smaller area the movement is able to fill.
• With wrist movement being devoted to the act of playing, the wrists become disabled from creating nuance in technique, dynamic range, etc.  Players need to decide what they want from the music they play.

        Will I therefore teach students to play with a wrist action?  Likely, no.  The resulting overtones produce a tone that is more thin and brassy than my ear is accustomed to.  (Wrist playing may why so many dulcimer players resort to leather-backed hammers.)  And these days I am learning more about how my wrists contribute to whole-body action, some I and my students would lose if our wrists became the focus of hammer action.  I achieve a pure, fundamental tone in my playing with wooden strike surfaces as it stands now, and will continue to nurture this within myself and my students.

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How do I know when my wrists are in neutral?

Finding neutral wrists is quick, easy and fun!

• Hold your hands out in front of you, palms down and fingers in light contact with each other.
• Tuck both thumbs under your hands so you can't see them.
• Now look at your hands in relation to your arms.  When the hands/fingers come straight out from the arm, the wrists are in neutral.  When the hands/fingers angle to the arms, the wrists are bent.[35]

Back to list of dulcimer questions    Return to autoharp question about neutral wrists

Is it better to stand or sit when playing?

        I do both, standing to perform concerts, and sitting to play contra dances or sometimes to practice at home.  Either way, I set up the dulcimer to achieve the greatest biomechanical advantage when playing.  Set-up helps impact my sound in positive ways.  Dulcimer height and angle change with each orientation.
        When standing, again the optimum angle range for the dulcimer is 8-15 degrees.[7]  Within this range, all kinds of wide-angle movement become available by moving one foot (I move both feet while playing, but only one at a time) forward, diagonally, sideways or backward and swaying the body around to take the hammers all over the soundboard without opening the arms excessively to reach far-away strike points.
        When sitting, the optimum dulcimer angles are 20-25 degrees.[7]  Duplicating the kind of movement that comes from standing originates now from the pelvis instead of the feet, combined with the distance of the chair from the dulcimer, which is partly determined by the key(s)/range being played in.  It is important to have both an adjustable stand and chair when sitting to play.  If the stand won't go low enough to assist biomechanical advantage, an adjustable chair can be raised.  And if the chair is non-adjustable but too high, you can raise the dulcimer stand.  Either way, remember that both feet need to be on the floor.  Feet resting above the floor on stool rungs present balance difficulties.[10]
        Why are the tilt ranges different for standing and sitting?  (Yes, I find this curious, too.)  This seems rooted in core movement originating from the feet for standing and the pelvis for sitting.  The steeper tilt for sitting simply enables the player to cover the same lateral range over the strings with much the same ease from the pelvis as a standing player would from the feet.

        I can't thank you enough for all the dulcimer stand information. I came home [from your workshop in Albuquerque] and immediately *fixed* my 2 stands; I feel much better....  The new [tilt and height] makes playing so much easier, not to mention more accurate. I didn't realize how much I was *fighting* the dulcimer's [set-up].  Thank you for everything!!        --Harriet Marvin, beginner (not rank any more!) dulcimer player, Texas

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Should I wear wrist splints while playing the dulcimer to avoid bending my wrists to strike the strings?

        No, because*:

• the wrists need to be flexible when hammering.  The truth is, for the hammers to be ready to strike anywhere on the dulcimer, the hands need to remain somewhat level while playing.  The only way they can do that with the arms going up and down all the time is if the wrists adjust, similar to shaking hands with a friend.[20]
• I've seen dulcimer players who wear splints still try to hammer through them with a wrist action.  No benefit there.  It would seem that dulcimer players who bend their wrists despite such splints would experience even more pain, fighting against imposed rigidity.
• I believe that at least part of the wrist pain for a dulcimer player comes from how the hammers are held, so adopting a neutral hammer hold is a safe and free solution.  It will also help to avoid a "pinch grip" between the fingers and thumb when picking up items in the course of performing everyday tasks.
          A cashier at my local supermarket routinely picks up 3-5 lb. packages of meat with a pinch grip, and the two wrist splints he wears indicate that this habit is giving him grief.[13]

        *If you are prone to bending your wrists while sleeping, wrist splints will help at night.  Help your nighttime efforts out by focusing on retraining during the day.

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I've been holding my hammers "out of whack", according to what's on this page, for a long time, and I don't feel any pain.  What's so bad about the "pinch grip"?  It seems like every player I know is using it!

        Well, let's take our time on this thought.  Bear in mind that tension distorts sensation[35], which means we don't feel pain when our muscles are tight as banjo strings.  But when we release those tense muscles and restore neutral, we then often discover that we were in pain when under tension.
        Here is a dulcimer-related case in point: I once worked with a dulcimer player--a nurse, in fact--who claimed she didn't have any pain from "pinch-gripping" her hammers.  From the hammers' playing position, she pointed to the top of her forearm just above her wrist while explaining to me that this area needed to be relaxed (ironic, because her wrist was stuck in ulnar deviation, which meant that she was already placing a lot of stress on that area).  I then showed her a neutral hammer hold, which she continued to use while we went on to explore how she could incorporate core movement to play freely.  About 20 minutes later, she had had enough time to play with the neutral hold to feel the previously unnoticed pain in the "relaxed" area of her arm go away.  (Note: Before this, she had been playing some tunes by herself with the pinch grip, so she was already "tuned up" to feel a difference.)  She confessed then and there that she didn't know that the pinch grip had been pain-producing.  So, while you may not seem to feel pain--anywhere--from a tension-laden hammer hold, it may be that you have yet to experience a neutral poise in the hands and wrists to understand what it's like to play the dulcimer pain-free.
        The reasons you may not have experienced discomfort or injury due to a pinch grip could be based on the kinds of tunes you're playing (slow tunes like waltzes, rather than driving reels with multitudes of notes), how often you play (once a week vs. every day) and for how long (15 minutes per session vs. two hours on your own or at the local jam session).  As more and more players are discovering, when the amount of playing and number of notes played per minute steps up, pain can "mysteriously" appear when the hammer hold and other points of playing are "out of whack."  Plus, your dulcimer and your ears (and everyone else's) miss out on the deep, sustaining resonance that comes with a neutral hold.  Why settle for average when you can have incredible?

And now a postscript to the above response from Kay S. Hooper, B. Mus., M. Mus., ATI Certified Alexander Technique Teacher:
        "One of my Alexander Technique teachers, Bruce Fertman, said that the brain learns by contrast, better or worse, darker or lighter, faster or slower, and so on.  So if we have no point of comparison, we tend to go with habit.  Further, it can be suggested to a player that maybe he or she will play better or have more enjoyment from playing by making a change, which can then lead to the discovery just explained in the above response to this question.
        "I have a 20-year-old Alexander Technique/piano student who has the most damaging ideas about playing.  He was an athlete in high school and quite muscular, so I think he got through for a long time without pain because of the sheer strength of his muscles.  This also contributes to his piano-playing issues, because he has the common connection between strength and tension that weightlifters can get: the ideal of tight muscles as a goal, the tightness being unnecessary for playing the piano.  As he continues to release this tension, he is discovering how much of both his pain and his technical limitations are due to his belief in tight muscles as being ideal.  He is also realizing that he has control over the tension/pain pattern."

(Kay is the author of Sensory Tune-ups: a guided journal of sensory experiences for performers of all ages. In this book, she describes lots of great ways to tune in to the body while playing any musical instrument.  Check Kay's book out at www.allsensepress.com.  –LR)

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I have arthritis in the joints of my fingers.  Should I still attempt the neutral principles of holding the hammers and striking the strings as you advise, or am I on my own?

        For those with arthritis and other "digital challenges," come as close as you can to assume neutral, as described in the previous question.
        Thus far, every digitally challenged dulcimer player I have worked with has been able to strike the strings via the forearms by opening and closing the elbow joints.
        Hammer hold for the digitally challenged is often more tricky.  Thankfully, holding the hammers in neutral uses the entire hand, instead of the thumb and index finger only.  Some digitally challenged players have done fine with this hold, although others struggle with it.  It all depends on the nature of each digital challenge, and no two are alike.  The whole idea of hammer hold--for every dulcimer player--as presented in the text and photo of this question above, is to minimize the amount of physical pressure applied to hold the hammer: The more pressure the thumb places on the handle, the harder it is to hold the hammer securely!
        I am unaware of hammer makers who design handles for digitally challenged dulcimer players.  I highly recommend, of course, that any hammer makers doing so would design the handle so that the player can hold it with the thumb aligned with the hammer shaft, rather than angled to it.  It never ceases to amaze me how the aligned thumb and forearm positively impact the dulcimer's resonance, something every dulcimer player deserves!  Beyond this, an aligned thumb allows adequate thumb flesh to secure the hammer in the hand.
        If you are a hammer maker reading this response and can fashion hammers for special needs, please   so I can pass your contact information on to those in need.

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Autoharp questions

What are the likely causes and effects of autoharp-related injuries?

(Note: String hand (arm, thumb, etc.) is the hand or other body part connected to wearing the fingerpicks; button hand (thumb, etc.) is the hand or other body part connected to depressing the chord bars.)

        Some of the causes of autoharp discomfort are:

• Positioning the autoharp low in relation to the body/forearms.
• Forcing the player's head forward from the neck to see the strings.
• One or both wrists is/are in a constant state of forward flexion (oddly, I've noticed this to be the left wrist for women and the right wrist for men, but there seems to be a good reason for this).
• One or both wrists in radial or ulnar deviation (bent sideways, like a windshield wiper, and stuck there).
• Picking the strings with a "bear-claw" string hand, where the fingers bend from the "doorknocker joints."
• A misconceived perception of where to pluck the strings with the picks.
• Strumming by using only the wrist.
• Strumming by using only the thumb.
• Mismapped (misunderstood/misperceived) arm structure, particularly regarding arm rotation.
• Mismapping the hand in the arm structure when playing "thumb lead.".
• A motionless string arm, with wrists, fingers and/or thumbs alone doing the playing.
• "Hitchhiking" either thumb back and away (the left thumb is barely used, the playing thumb has times when it doesn't play).
• Picking all the melody notes, especially fast notes, with one finger.
• Routinely using the button thumb to depress chords (usually when the I-IV-V buttons are set up in triangles instead of in rows).

And here are the results:

• DeQuervain's tenosynovitis (resulting in pain generated in the "Gaza Strip" between the thumb and index finger; you'll recognize this area easily in the left hand; look for its mirror in the right).
• Strain/tingling in the string hand.
• Strain/tingling in the button hand.
• Wrist of the string hand tires from strumming quickly.
• "Crunching" of forearm muscles in string hand: The autoharp's height may need to be reset to place the string arm in neutral position over the strings.
• Co-contraction via strumming from the wrist or thumb from a motionless forearm.

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What are some tangible things I can do to avoid injury when playing the autoharp?

• Balance your head on your spine.[10]
• Sit on an armless chair with a sturdy seat (those portable, mushy canvas chairs at festivals are convenient to tote around, but...).
• Set up your autoharp in relation to your body so you can play with free arms and neutral wrists (see next question).
• Remove your playing arm from the body of the autoharp; a quarter inch will do the job.  This frees not just your forearm but also your elbow, so that you can experience the entire length of your arm when playing and reach all the strings on the autoharp with ease, especially the highest strings.
• Use the large muscles of your arms to play (see next question).
• Explore all the ways your shoulders and arms can move, as well as all the joints of the arm.  They are designed to go all over the place![34]
• Use more than one finger to pick melodies, and alternate those fingers in fast passages.  I use index, middle and ring (plus the thumb for harmony below, of course); the index and middle get the most use, but the ring finger is in there enough to smooth the playing out.  This does marvelous things for phrasing the music, by the way.
• Where possible, let the fingering order of many notes follow the shape of the melody: For notes going up, it's i-m-r; for notes going down, it's r-m-i.  Note that other fingering combinations come into play, such as one that I call "the wave" (r-m-i-m).
• My own downbeat pinches for diatonic playing are usually (but not always) the index or ring finger plus the thumb.  I'm not sure where a downbeat pinch with the middle finger came around, but considering the previous point, this doesn't make sense.  The middle finger is longer than the index, so when the string hand is positioned over the strings, the middle finger is naturally poised to strike a higher string.  Middle-finger pinching also sets the hand in a "rest" position of ulnar deviation (hand pointing down from the wrist), far from rest.
• On the string hand, bend the fingers from the knuckles when fingerpicking.  The other finger joints will bend slightly, too, but without letting the fingers curl up; curved fingers are key.  Avoid originating the bending from the "door-knocker" joints (the next set of joints down from the knuckles), which usually comes from a static playing hand hovering too close to the strings.  To avoid crunching the fingers at the door-knocker joints, lift your hand away from the strings after each pinch.  Lifting the hand comes from the arm, by the way, not the wrist.
          A doorknocker-joint bender who converted to bending at the knuckles to pinch-pluck shared this with me about the improvement in her diatonic, "pumping felt" autoharping as a result of the change: "I felt like I had arthritis in my finger joints when I awakened in the morning.  [The pain] would work its way out during the day, but I think that playing the autoharp definitely was a part of this (although not the total problem).  I am not having that problem now, and so feel that the fact that I was trying to curl my fingers over the strings was directly at issue.  I have a long way to go to get my [hand away from] the autoharp and [teaching my fingers to bend] from the knuckles, but it is definitely better."
• On the button hand, use the entire forearm to depress chords with the index, middle and ring fingers, not just the fingers themselves.
• Avoid using the button-hand thumb routinely to depress chords, as this creates undue stress and takes the left wrist out of neutral.  I rarely use the thumb (for only two pieces in my repertoire, and in each very seldom) to depress the Isus4 chord in the bottom row, doing so only with the side of my thumb.
• If, when holding a diatonic autoharp upright, the lockbars are nearest your nose, do not rest the button thumb atop the closest lockbar.  Instead, poise it naturally over the chord bars (avoid a "hitchhiker thumb").
• Release the inactive button thumb and partially inactive string thumb to restore their slight neutral curve forward.  You'll probably want to keep an eye on both while playing so your eyes can teach you what to feel.  To avoid bending your head down and subsequently throwing your neck out of alignment, watch your thumbs in a mirror.[33]
• Should the finger joints "hyperbend" in the opposite direction when depressing chord bars, raising your hand a little higher (from the floor) over the chord buttons, as well as a little further away from the buttons, can help.  You might also check the wear on the chord-bar felts and the action on the bars if you feel like you're working too hard to depress them.

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Is it better to stand or sit when playing?

        I sit, but am currently researching autoharp placement for standing because so many players stand to play.  My reasons for sitting are these:

• For the solo work I do in performance, I believe that sitting looks more "classical" and congruous with the type of playing I do.
• I sometimes play with my eyes closed, and don't want to fall over!
• For the sake of amicable ergonomics that I haven't yet been able to find standing up.

        So, what do I know about standing?  A little study and experimentation at the June 2007 Mountain Laurel Autoharp Gathering and since sheds the following light as of July 27, 2007:

• The arms must be situated so that there is no need for them to support the autoharp's weight or tilt.  That goes for sitting as well as standing, but the point here is clear: If you're going to stand to play, you need something that will support the autoharp while it's on you without your help.
• One joint, and possibly two, in the arm structure are missing from the body maps of many players.  As a result, many autoharpists play with unnecessary tension, and possibly also think that their arms are shorter than they really are.
• Autoharpists cannot rely on a specific, fixed point on the body by which to establish autoharp height when standing to play.  One woman at MLAG 2007 shared with me a suggestion given to her that the uppermost corner of the autoharp land 1½ inches above her ear.  Once she, at 5 feet tall, found out where her arms needed to be in order to play freely, the top corner of the autoharp landed two inches above her head!  The location of the autoharp on a 6-foot autoharpist will be different again.  When the body size changes while the size of the autoharp does not, fixed points of reference on the body prove to be unreliable.
• Most standing autoharpists wear the autoharp too low in relation to their lower arms.  At MLAG 2007 and the ODPC Funfest in Evart MI, I demonstrated how to find the best autoharp placement for any body type, which is higher for most players than initially thought.
• I am finding that autoharp strap arrangements as we know them are designed with a man's upper torso in mind, which a woman's bust line confounds.  Since MLAG 2007, I learned that once a strap set-up, including strap-button placement on the autoharp, is designed for a woman, it will also work well for a man.
• Although the "Slider" strap seems to have been designed specifically for autoharp, at the moment, it routinely sets the autoharp too low to the arm structure.  However, I am seeing a glimmer of hope that may turn this around as experiments continue.  We'll see. 
• Setting the autoharp high enough to maximize arm-structure function often causes the top of the autoharp to tip far over to the player's left, causing severe bending in the right wrist when playing.  In the case of the "Slider" strap, the shorter loops that would raise the autoharp also causes discomfort in the left armpit area.

        All I can say right now is to stick with this page to see how all of this will turn out, hopefully for the better!  (Ladies, the jury is still out on what's best for us.  I advise holding off on purchasing a strap of any kind until more is known.)  For the moment, sitting to play is the best way to establish and use an optimum autoharp height for you.  Go on to the next question for set-up how-to information.

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It sounds like neutral wrists are essential when playing.  How do I find neutral wrists?

        First, click here to learn about neutral wrists.
        As I mentioned two questions ago, what I've noticed is that the left (button) wrist sustains flexion in women, while the right (playing) wrist sustains flexion in men when the autoharp is held upright against the chest.  While that sounds curious, there seem to be some good reasons for these differences.

        First, a couple general points:

•  Despite gender, all autoharpists are created unequal, with differences in arm length as well as height and girth (and where the girth is: in the bust line or the "beer belly").  For example, it's possible for a tall man to have shorter arms than a man who is shorter in height.  Likewise for women.
• The autoharp needs to be stabilized.  If you have to hang on to it with your forearms while playing to keep it from running away, you'll have to tense up a good portion of both the arms and upper torso to do that.  The solution doesn't necessarily mean attaching straps to the autoharp and wearing it.  I'm not so sure wearing the autoharp to stand is advantageous.  While it seems that the straps that cross in back clear the shoulder blades, the autoharp still presses a downward pull upon the spine by virtue of its weight (this is most noticeable in the pelvis, which may tend to tilt forward and upward, to "balance" the body while the autoharp is being worn).  Downward pull is not a free feeling for anyone, whether wearing autoharp or not.

        What follows is a lump sum of solutions.  Please note that they are based upon sitting to play.  Read everything, then use what applies to you, and feel free to make adjustments; none of this is static, but dynamic.  As I said, our bodies are all different, so it takes moving limbs and joints around to find what works.  A mirror nearby can help you while you're searching.

Left wrist

        When the left (button) wrist flexes perpetually, two things are usually going on: 1) the left elbow is too far back, likely next to the body; and 2) the autoharp is low in relation to the left hand and arm.  The elbow being too far back tends not to be a problem for men because they lack the "anterior endowment" that women have.  However, a couple of male autoharpists hold their autoharps quite high, and they may have unwittingly caught on to the biomechanical advantage that this position affords.
        So women: Note that moving the elbow forward enough for the forearm to release wrist flexion means that the elbow rises, too (remember: the upper arm is on an axis at the shoulder).  This creates a new situation: the autoharp becomes low to the hand, which is why the left wrist bends down: the fingers need to reach the buttons, but this flexed position leads to strain.  The way to a neutral wrist, then, is to raise the autoharp.

        For years, I crossed my left leg over my right to raise my autoharp, but discovered during the body mapping class I took in June 2005 that my playing endurance and right-hand finger freedom increased, in addition to gaining a neutral left wrist, when I raised the autoharp even higher. While normal cross-legging may raise the autoharp enough for some players (and if it does for you, that may be okay, but keep reading), it wasn't for me, despite my seemingly "lanky" arms.  The trick was finding a way to anchor the autoharp atop something that it wouldn't slide off.  I made and tried out "prostheses" from layers of sturdy craft foam, pillows, a flattened roll of organic toilet tissue (nothing but the best, but try explaining that to your audience during a formal concert)...the autoharp was never positioned quite right, and it slid around and eventually off the object.
        In July 2006, I was astonished to realize that I'd been wearing the answer for several years: a hip pouch.  Notice in the photograph below right that my pouch has a "lid", as shown by the zipper curving around the top front, rather than being shaped like a large, external pocket, where the zipper goes across the top and center.  
(At its widest point, the lid measures 3 1/4 inches, excluding the black zipper tapes.)  My usual contents of wallet, eyeglass case, etc. being too rigid to allow shaping the lid into a kind of  "seat" for the autoharp, I went to the grocery store and bought a 1 lb. bag of peanuts in the shell, most of which went in a small plastic sack (like the type you get when buying a couple small items at a drug store), and then placed the filled bag into the pack.  The peanuts are lightweight and malleable within, enabling me to create a shallow "well" in the top of the pack's lid that the treble-string corner of the autoharp won't slip out of, thanks to the curved zipper.  (Everyone asks about using Styrofoam peanuts instead, but these will flatten in a short time.  Now, if you want to eat the peanuts, try dried navy beans instead!)  If the autoharp needs to be higher or lower, just add or remove the peanuts/beans, and adjust the belt if necessary.  My pack belt is loose, slung over the top of the pelvis rather than being snug around the waist; the pack being positioned more toward the left front of my pelvis when I'm standing.  Plus, the belt prevents the bottom of the autoharp from pushing itself and the pack away from my body.  The result is more than neutral wrists: I now play with two free arms, both feet on the floor, a tension-free right side of the body (the tension there came from playing cross-legged), and great endurance for fast picking!  I feel open and free.  Note: If you need some height, and a hip pouch raises the autoharp too much, try wrapping a hand towel or whatever around an old necktie or a longer belt than what you would normally wear around your waist.  If you're tall and need more height than the pouch can offer, fold up a towel and place it on your left thigh under the pouch (not the autoharp).
        You can find a hip pouch similar to what's shown at right at www.cabelas.com.  Once there, copy and paste this catalog number in the Search field: 2UG-590895.
        To see the pack in use while playing, click here.  But note: To apply this idea, your spine must first be well balanced.  This means the head balances atop a lengthened neck/spine, and all of this in turn balances atop a neutral pelvis.  Those autoharpists who have reported that the fanny pack doesn't work for them play with their torsos caved in (the spine is "hunched over", the head is forward and the pelvis tilts up, aka, classic downward pull).  The resulting spine curve shifts the body's weight off the weight-bearing spine to distort the torso's length, applying unnecessary pressure to the back.  Situated this way, these players make themselves too short in the torso to reap the benefits the fanny pack would give them if their spines were lengthened and balanced.

Right wrist

        While both men and women are capable of bending the right wrist into sustained flexion, men tend to flex it more routinely because they lack "anterior endowment."  The trick for everyone, then, is to simply bring the right elbow forward, and the men might also bring it out to the right a little, too.  (I don't anticipate the upward movement of a man's elbow to necessitate a much higher autoharp, because the right elbow doesn't need to come forward as much as it will for a woman.)
        One of the other things that causes sustained flexion in the wrists is using both forearms to stabilize the autoharp while playing.  Leaning the right forearm on the autoharp means more than bending the wrist perpetually so that the fingers can reach the strings; it also means anchoring the hand over one section of the strings, limiting the number of strings that can be reached comfortably.  A fanny pack or similar "prosthesis" will assist freeing both arms, as long as they are off the autoharp, while neutralizing both wrists.

Right-hand fingering (for diatonic autoharp; chromatic players, click here!)

        Right-hand fingering for most diatonic autoharpists of the "pumping felt" persuasion comes down to two-finger playing, pinching exclusively with the middle finger and thumb (m-t) and plucking with the index finger (i) alone.  Playing up a scale with the m-t/i pattern bends the hand sideways from the arm (towards the floor when holding the autoharp upright), taking the right wrist out of neutral into chronic ulnar deviation.  Reason: The index finger has to reach out beyond the index finger to reach the string, and the easiest way to get it to do that is to perpetually bend the wrist sideways.
        Now take a closer look at the right hand: Hold your autoharp up to play and hold your right hand over the strings in playing position with a neutral wrist.  Now look at your fingers.  Of the index and ring finger, which one is already poised to strike a higher string?  Of course you see it.  It's the middle finger, because it's longer than the index finger.  When the pattern reverses to become i-t/m to play up a scale, the wrist can maintain a neutral position, which in turn does great things for ease of playing.  Further, the player's expectation to use ring finger as well poises the hand to encourage a neutral wrist.[36]
        Does this mean that a middle-finger pinch is never used?  No.  Right-hand fingering need to be as flexible as melodies eternally are.  (Piano fingering shows how varied the patterns can be.)  My basic rule of thumb (no pun intended) is to let the index, middle and ring fingers follow the shape of the melody, instead of pinching routinely with only one finger.    But following the melody's shape isn't hard and fast, either!  If you would like to pick up some additional fingering patterns that I personally find useful,  about teaching a workshop in your area.
        (Chromatic players, take note: Same-finger pinching will tire your hand, and has been known to create pain for some players.  Even though this thought has nothing to do with the wrists, it still has to do with playing freely.)

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I've been taught to strum by not pushing my thumb across the strings with my arm.  What do you have to say about this?

        I've heard this, too, and you should know that it's the lack of movement when playing the autoharp that will hurt you.  We need to engage those large muscles to play safely--and musically!  But, now for a little perspective, because this instruction strikes me as needing some more careful observation.
        I believe that those who talk about not pushing the pick with the arm are referring to not pushing with the entire arm.  However, because what to do isn't supplied, autoharpists hearing this instruction conclude that the arm must not be used at all, and consequently strum and brush only from the wrist or thumb, flexing one or the other exclusively.  (Teachers, take note!)  Both interpretations swing the pendulum in the opposite direction, causing many autoharpists to miss a worthwhile--and healthy!--in-between point.  You'll hurt yourself strumming with just your wrist or thumb, while denying yourself the pleasure of fully resonant sound.
        Strumming in all its forms takes quite the vocabulary of subtle and assertive movements, depending on the strum's function and the effect you want from it.  When you strum the autoharp like a guitar to accompany your singing or to back up melody instruments in a jam session, most of the movement comes from the forearm going up and down, as a result of bending the elbow.  The whole arm is not needed here, but part of it is quite useful, as you can see in the thankfully "fuzzy" photo at right, where I'm strumming away during one of my solos in a concert.  Notice the range covered by both the forearm and the hand.  My elbow and upper arm look quieter, but they are not static.  That's because my body is also moving while I play.  When strumming with the forearm, my wrist is free enough to respond naturally to the forearm movement, and my thumb's sole function is to support the pick.  Neither thumb nor wrist forcibly flex to create playing action.  They don't have to, because my forearm does the strumming.
        However, now look at strumming just the high strings.  The elbow must open more so the entire arm can center the hand over the high strings.  Once the hand is placed, forearm strumming resumes.  So you see, the entire arm cannot remain static; it's a dynamic structure in need of constant engagement and readjustment (this goes for picking strings, too).  This is why I recommend playing the autoharp with the forearm off the autoharp; a 1/4 inch away is all it takes.  When you want to change ranges, make big jumps, etc., an arm free from anchoring the autoharp lets the elbow open so the hand can move to where it needs to go.  So, for accompaniment strumming, the instruction you've received is correct: You don't want to strum by pushing the pick over the strings with your entire arm.  That would tire you quickly, and might become painful in time.  But you still need your entire arm to head your hand toward the strings you want to strum.
        Whole-arm strumming isn't entirely a bad thing, either, and therefore shouldn't be discounted; in fact, it does wondrous things.  First of all, how else are you going to take the pick across all the strings when you want to zing the ending of your most fabulous piece?!  You can't do it with just the thumb, wrist or forearm.  However, whole-arm strumming--or brushing, as it usually turns out to be--is occasional, often used to fill in the "silent" beats within long note values to keep the beat going (such as pinch-brush to play a half note, and pinch-brush-brush-brush to play a whole note).  I often brush by using my entire arm, and it feels good.  If I brushed with only my thumb or wrist, I wouldn't get the quality of sound that allows the music to breathe, and I might eventually inflict myself with a lot of pain.
        So, whether strumming to accompany or brushing lush chords for filler, the thumb takes an inactive role, and the wrist responds to the arm movement, rather than either one initiating movement.  If you compare the sound of one strum each by the thumb, wrist, forearm and whole arm, I am confident that you will also hear a distinct difference in volume and resonance that will help you choose the kind of sound you want at any given time to always sound your best.
        And here is a side note: Whenever you see "T" (for the thumb) in music notation, remember that this symbol indicates the digit that strikes the strings, rather than an instruction to move only the thumb to sound them!
        In conclusion, the more your entire body is involved in playing, the freer it is to move (remember: when we can't move, we can't play), and the rounder the autoharp's sound becomes.

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Copyright 2006, 2007, 2008 Lucille Reilly.  All rights reserved.
No portion of the contents on this page may be reproduced for mass production without permission of the author;
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Research

1.       Comparison of hammer holds and their effects on tone quality.  (Reilly, November 1985)

2.       Sound comparison of striking a course with a neutral hammer hold and forearm strike to a thumb-extended hold and wrist strike: The oscillating waves shown in the curve of the neutral hold displays are smooth, while the wave of the thumb-extended hold is jagged.  The tune "Petronella" was also played with both hammer holds/strike types.  (Reilly, January 2005)

3.       “The Forearm Tower,” a method to quickly find neutral hammer hold from a vertical forearm.  Both students and non-playing subjects participated in this study. Once the thumb was neutrally placed, the author asked subjects to slowly slide the thumb tip toward the tip of the index finger to replicate a commonly used, injury-prone hammer hold.  Subjects experienced muscle discomfort anywhere from the wrist to the shoulder.  (Reilly, March 2005)

4.       Applying and withholding core movement in music making: The author and her students explore playing the dulcimer both with and without leaning, turning, shifting and panning over it.  Pain in the neck/shoulders area ensues when playing without core movement.  (Reilly, November 2005 to present)

5.      Wrist and arm hammering and their effects on tempo.  The author played the tune "Cincinnati" and used a metronome to determine the fastest threshold tempo (where the tune loses steadiness of strikes within metronome beats) when playing with "rough" wrists (torquing the forearms with almost undetectable stopping after each hand strikes), "smooth" wrists (continuous, equal exchange of up and down wrist movement) and bending the elbows.  Thresholds were as followed, based on four eighth notes to one metronome beat: rough wristing=108 (note: dance tempo of reels ranges from about 100 to 120, making most of this range feel uncomfortable); smooth wristing=132; elbow bending=152.  (Reilly, August 2005)

6.      Determining any player’s rest distance between a central strike point on the dulcimer and the hammer’s strike surface prior to playing (the rest distance does not establish a boundary for hammer height when playing; rather, it ensures that there is enough strike space underneath the strike surface of the mallet for free movement in playing to take place): The author developed quotients that can be multiplied to the measurement from the Olecrenon process to the strike surface of t