In this issue, you can choose any of these articles:

  • Freedom From Pain: The Angled Headjoint by Amy Rose
  • A Success Story: Anna Belle O'Shea by John Lunn
  • Pain Management Using Massage Therapy by Susan Weiss
  • Return to HANDS ON! menu

  • FREEDOM FROM PAIN: The Angled Headjoint
    by Amy Rose
    Before finding the 30 degree angled headjoint, I thought my flute playing career was at an end. With the standard straight headjoint, my neck was bent and twisted along with straining and stretching of my arms and fingers. I had pain in my neck and numbness in my left hand and arm. I have been playing on the angled headjoint for 3 years now and any pain or numbness is totally cleared up. I can play for hours without any discomfort. Where did this design come from and why does it help players with problems such as mine? I'd like to share this information with you.

    Dr Richard Norris, director of the National Arts Medicine Center in Bethesda MD is the innovator of the angled headjoint. In 1986, he was working with a patient who had whiplash from a car accident and was unable to turn her head. At that time, he started experimenting with the idea of bending the metal of the headjoint to accommodate her problem.

    Dr Norris consulted with headjoint makers as to the feasibility of this idea. In working with Chris McKenna of Gem headjoints, he tried cutting a wedge out of the headjoint, then bending and soldering it, which created an angle that was too sharp. Later he consulted with Jim Phelan, then owner of Powell Flutes. They experimented with filling the headjoint with hot pitch in order to heat the metal and bend it. However, each attempt cracked the silver.

    Teaming up with Mark Thomas of Emerson Musical Instruments proved to be a success for the angled headjoint. The first headjoint they made was the 150 degree angle. This works quite well but needs to be stabilized. This can be accomplished in a couple of different ways. Clips or "Stedi Rests" designed by Dr. Norris allow the flute to be completely stabilized without pressing against the jaw and without even holding it with the fingers. Or the lip plate can be rotated to be in line with the trill section.

    Dr. Norris developed the 30 degree angle for children after seeing the standard "U" shaped Suzuki-type headjoint. Alto and bass flutes also have this shape headjoint. The "U" shape essentially creates a shortened straight flute. The elbow is still up in the air and the head needs to be tilted and the neck twisted. Dr. Norris opened up the angle thirty more degree. Having the flute body slope down and the mouthpiece horizontal resulted in a straight neck and relaxed right arm. Head and neck remain centered and facing forward. Left wrist and first finger are no longer bent at extreme angles. Arms are closer to center. The 30 degree angle also balances like a straight flute with the 3 point balance between lip, left hand index finger and right hand thumb.

    My 30 degree angled headjoint has some modifications. I bought a silver plated model from Emerson Musical Instruments, but felt that it was not responsive enough for me. Chris McKenna replaced the lip plate and riser with those made of sterling silver and put a professional cut on the embouchure. The results for me have been fantastic! Although the bend does not change the sound in any way, it does prompt inquiries from people who are curious to know what I've done to my flute! Most importantly, it's freed me from pain and made my flute career possible - proving once again that one size flute does not fit all!

    Amy Rose, a teacher from Amherst MA, plays flute and piano with the Klezamir band and flute with the Rosewood Duo.

    by JOHN LUNN

    In September 1988, Anna Belle O'Shea, then principal flute in the Northwest Indiana Symphony Orchestra, was in a serious car accident. Her car was forced 128 feet through an intersection at a red light by another car going 55 miles per hour. She spent 2 weeks in the hospital and was diagnosed with multiple nerve entrapment syndrome, specifically bilateral acute traumatic thoracic outlet syndrome and bilateral carpal tunnel syndrome. 

    After her recovery, she was left with pain in her shoulders, neck, arms and hands and a numbness and tingling in her fingers. Unable to play for the first 8-10 weeks, it became necessary to take a year's leave of absence from the orchestra. After a few months, she began playing for short periods but it became obvious to her that the hand positions on the flute itself were causing discomfort. Her neck pain worsened when she turned it to the left and both wrists hurt because of the need to bend them to reach the keys.

    At first she tried a cervical collar, wrist splints, bed rest and physical therapy. In 1989, her neurosurgeon performed carpal tunnel surgery on both wrists because of an increased numbness and tingling sensation in her fingers and loss of strength in both thumbs. The surgeries were successful and she regained the feeling in her fingers almost instantly. After a 6 week recuperation period she was gradually able to start playing again.

    Around the same time in 1989 she met with Dr. Richard Norris who suggested several modifications on her flute: closing the open holes and extending the keys of the left hand and getting an angled (curved) headjoint. She owned a Powell flute and had the work done at the Powell flute shop, where they also added a split E mechanism that was operated by a separate rod. Sandford Drelinger custom made a 30ø curved headjoint for her.

    The results were only 50% effective. The key modifications were helpful but not extensive enough and the curved headjoint was difficult to balance. Since they didn't enable her to recover completely she had to resign her position in the orchestra solely because of lack of endurance. She was only able to play for 30 minutes at a stretch and so she switched her career to teaching.

    In January 1994, Anna Belle sent her flute to me for a complete rebuild of the previous modifications. I extended the left hand keys much further, made them lighter, and raised the C# lever away from the flute tube to relieve the remaining stress in the left hand. I closed all the open holes in the right hand and added an Angled footjoint cluster to bring the right pinky close and comfortably into use. I then removed the split E mechanism and substituted a "lower G insert" to keep the 3rd octave E in tune while taking weight off the flute. Along with that I removed the C# trill rod and posts and rebuilt it on the main trill rod which also significantly reduced the weight. Finally, I experimented with the curved headjoint and found a way to balance it without crutches and forced hand positions.

    Anna Belle is now back in the free lance market, practicing and performing up to several hours a day. Through her perserverance and diligence, added to a combination of surgery, physical therapy, modified technique and flute alterations she has been able to hold on to her flute career. She uses the curved headjoint for practice but feels more secure with her straight one during performance.

    ~ John Lunn is a flutemaker who specializes in finding solutions to hand problems for flutists.~

    by Susan L. Weiss, Massage Therapist
    Pain in the body's soft tissues (eg: ligaments, tendons, muscles) can be a debilitating problem for musicians. Massage therapy can be a useful tool for a musician that needs to help control stress, or that has been diagnosed with tendinitis or myofascial(connective tissue around muscles) trigger points(areas of hypersensitivity). This article will address the lesser known forms of massage therapy that help control tendinitis and trigger points. These types of massage therapy would not be classified as relaxation. The work is sometimes very intense. However, the therapist will always follow these therapeutic methods with relaxation massage techniques. Neuromuscular therapy and cross-fiber friction should be done only by those specially trained in these techniques.

    Neuromuscular therapy is based on the work and research of Dr. Janet Travell and Dr. David Simons. Their research showed that areas of waste build up of lactic acid and other metabolites can cause trigger points in the soft tissues of the body. These trigger points can transfer pain away from the injured or irritated spot. In this type of massage, the therapist would examine by touch to find the area of irritation and use compression into the trigger point. Simply, this interrupts the nervous system activity in the area and allows blood to return to the muscle tissue and flush the waste products. Stretching of the involved muscles following the release of the trigger point helps to restore flexibility to the muscle and tendon. Areas that are prone to this in flutists are the muscle at the top of the shoulder, the back of the neck, the forearm and hand. They can cause headaches, a burning feeling at the spine and the base of the neck and make it difficult to grasp or hold items such as the flute.

    Another type of massage therapy is cross fiber friction. This therapy is based on the work of the British orthopedic physician, Dr. James Cyriax. Cross fiber friction is used on scar tissue. Scar tissue forms when there is any tearing in muscle, tendon and ligament tissue. It does so in a random pattern, so the scar that is formed has less integrity than the original structure it is replacing. The massage therapist would begin cross fiber therapy after a physician has diagnosed an injury (eg:tendinitis, tennis elbow, muscle tear). It would be helpful if the massage therapist works with the diagnosing physician so progress can be observed. Cross-fiber friction works by breaking scar tissue down and promoting the arrangement of properly aligned, flexible tissue. This frictioning also brings more blood into the area. Clients typically would be seen 2 or 3 times per week. The consistency of the work aids to the correct formation of the tissue. In general, a fresh injury takes 4-6 weeks to heal with treatment and an old injury takes 8-12 weeks. These are generalizations and time varies depending on the age of the injury, whether it is repetitive injury, the clients health, and whether the client avoids reinjury during treatment. Frequency of treatment can lessen as recovery proceeds.

    Trigger points and tendinitis often occur from overuse. Overuse injuries frequently stem from postural or biomechanical problems of playing the flute. If this is the case, help from practitioner of the Alexander Technique or Feldenkrais Method can help the musician properly align their body. Physical therapists and some massage therapists can also work with the flute teacher to adjust habitual biomechanical problems.

    Soft tissue pain in the musical is best managed with a team approach - a physician who diagnoses the injury, soft tissue treatment by qualified massage therapist, rehabilitation by a physical therapist, postural retraining by practitioners of Alexander or Feldenkrais techniques and consulting a flutemaker about having your flute modified to reduce the strain that be causing these problems.


    HANDS ON! is a public service provided by John Lunn Flutes
    The opinions expressed are not necessarily those of the editors.
    If you have questions, comments, articles, ideas or letters to the editor, we'd love to hear them.
    If you are in pain or experiencing phyical difficulties while playing, contact your healthcare provider.