Francesca Leo: Tendonitis and the Mind-Body Connection

This past year has been a transformational experience in my path to recovery. In early 2020, I graduated with my master’s degree in classical flute performance during a global pandemic, I was entering a significant transitional period in my professional life, and I was continuing to manage flare-ups of a chronic performance-related injury that began in 2013. 

During the time of my injury, I thought I was the only person in the world to experience pain from playing an instrument. I felt isolated, angry, and scared about the future of my career. My pain began at age 16 when I received my first diagnosis of tendonitis in both forearms. At the time, I was advised by my doctor to stop playing my flute, take painkillers as needed, and apply ice and heat to the injured area. Not knowing that I had any other options, I ignored this advice and continued to practice and play in ensembles for five to six hours each day. I loved playing my flute, and I joined every single performance opportunity available to me in school. The thought of having to give up my flute gave me great emotional distress. Because I did not want to miss out on any rehearsal time, I would frequently play through severe burning sensations in my forearms, and I never took breaks. I knew that becoming a professional musician was the path I needed to follow, and I would have done anything to make that happen.

In 2014, I began my undergraduate studies as a music performance major. I received a serious wakeup call during my first round of placement auditions, being placed last chair in our concert band after spending years in high school playing principal. This really came as a shock to my young self, and it led to me spending countless hours of “punishing” myself in the practice room. This was a term that was recommended to me by an early private teacher, whose lessons I also frequently left crying. After a while, this practice behavior, combined with low self-esteem, the pressure of a competitive environment, perfectionistic behaviors, and an anxiety disorder, significantly worsened my pain until I could not play for more than five minutes without experiencing shooting pain sensations in both arms. I was constantly pushing myself past my physical and mental limits because I told myself that someone else was “practicing harder” when I was resting. I was really struggling mentally for many years, and I took it out on my body. I was afraid to ask for help.

In 2016, I reached my personal goal of being placed as first chair. I began to win prizes in some competitions and gained some more confidence in my playing. This newfound confidence helped alleviate some of my pain symptoms, and as my symptoms slowly improved, I began to feel human again. Things took a turn for the worst shortly after that. The repertoire assigned in this ensemble was really difficult, and I was having trouble keeping up with practicing ensemble music, preparing new repertoire each week for lessons, staying on top of assignments, and continuing to enter competitions. I was preparing to the best of my ability at the time, but it was still not enough. I was really nervous before each rehearsal. When I made a mistake, the director began singling me out in front of the ensemble, telling me to play the passage until I got it “right.” This became a frequent occurrence, and I didn’t notice this happening to anyone else. I felt humiliated, and as I grew increasingly more nervous, I made more mistakes. I left so many rehearsals in tears. Some students began to notice this and began to talk badly about me behind my back. These statements came back to me. My pain symptoms came back in full force during this time, as I began reverting back to “punishing” myself in the practice room. I carried these negative words with me for years, and each time I made a mistake, I was reminded that I was not good enough.

There are some people that can find motivation out of being told that they are not good enough, that they need to work harder, that this career path is not for them. After being told all of this, I did not feel that I became stronger because of it. Each time I was told to any degree that I was not enough, my core belief was confirmed. It all took a major toll on my mind, body, and spirit. Some part of me wanted to prove myself, and to some degree I did. I was grateful to be accepted into my dream graduate program on a scholarship, where I later won the concerto competition. But I carried all of these words with me through every experience, and I had a really hard time believing in myself. I truly felt worthless, despite any degree of success that I had achieved. This led to leaving several more lessons in tears. 

I found my true calling when I first heard the term “performing arts health.” After I finally began to open up to others about my injury, I was met with overwhelming support and many stories of shared experiences. I conducted an IRB (International Review Board)–reviewed study in the fall of 2017 on the prevalence of performance-related pain and general stress levels for my undergraduate honors thesis, and my findings revealed that 88% of my peers were suffering from performance-related pain that affected their ability to play their instrument at the level to which they were accustomed. 

These findings were deeply disturbing to me, and I compared my results to several other studies with hauntingly similar statistics conducted on a much larger scale. This research combined with my personal story fueled my motivation to help others, and I created www.playingwithoutpain.com as an interactive website and social media platform to educate and support musicians with performance-related pain, injuries, and mental health issues. This work lights me up, and I find great passion through helping others overcome the same challenges I have faced and have been deeply affected by.

I tried many different methods of physical treatment for my injury, including physical therapy, the Alexander Technique, massage therapy, chiropractic care, and body tuning. I was engaging in regular cardiovascular exercise and taking frequent breaks to stretch and rest during practice sessions. For several years, I maintained this regimen of managing pain symptoms but never completely healed from my injury because I had to meet performance requirements in school. I continue to discover new information about my injury and continue to face challenges in advocacy for performing artists in a medical setting, having received a recent diagnosis of a shoulder impingement and being told by a medical professional that the only way to heal was to stop playing my instrument completely.

The mind-body connection is incredibly strong, and this past year allowed me to begin work with a therapist to finally face my emotions. Engaging in a consistent meditation practice also helped me face the uncomfortable emotions and experiences I had been avoiding, begin to process them, and move forward. I became more connected to my body through this work as well, noticing when physical sensations arose and their connection to my emotional responses to triggering situations. This led me to noticing that the pain in my injured left shoulder and forearm would typically worsen when I was under emotional distress.

Through this self-reflection, continuing to conduct research in the field of performing arts health, and working with Madeline Bruser and Body Mapping educators, I’m also learning how to practice and study music on a much deeper level. I learned that singing through a phrase as accurately as possible allows me to connect with my true inner musician. And I learned the importance of rhythm embodiment through child-like dancing, and that free and uninhibited movement is a key component of feeling at home in my body. My physical pain has also reduced significantly since I’ve learned to embrace my authentic self and be unapologetic about it. I plan to become certified as a Body Mapping Educator and Meditation Instructor so that I can help others with problems similar to the ones I’ve had.

It’s amazing to reflect back on my eight-year journey from being diagnosed with an injury at 16 and feeling completely isolated and scared, to now feeling much more joyful and confident about performing. I’m grateful for all I’ve learned and for new opportunities that have come my way to share what I’ve learned at several musicians’ wellness conferences. I know now that transformation is truly possible, and I’m excited to be embarking on a career of helping others break free from frustrating and frightening limitations so that they can discover authentic confidence as performing artists. If we work on all aspects of making music—on freeing our body, mind, and spirit in practicing and performing—we can realize our calling to radiate joy and inspiration to our audience.

So I encourage you to believe in your own possibilities. Whether your issue is physical tension and pain, anxiety, or self-doubt, help is out there if you look for it. You can overcome these limitations to become the musician you’re meant to be.