Miami ? When you hear Ravel’s “Bolero” do you think of athleticism?

Janet Horvath thinks you should.

“That’s a piece almost everyone can recognize,” she said. “It’s a 14-minute piece; the snare drum plays an unwavering rhythm from start to finish. It’s a 24-note pattern over two bars repeated in endless time.”

Horvath counted the number of snare drum hits: 5,144, quite a strain on the wrists. When she told the snare drummer, he responded that she needed a hobby.

So Horvath, now in her 26th season as principal cellist with The Minnesota Orchestra, wrote and self-published “Playing (less) Hurt: An Injury Prevention Guide for Musicians” ($23.95).

“This book begged to be written,” she said. “Repetition hurts musicians. Even we don’t realize how much repetition we subject our body to and the awkward postures instruments require.

“Holding the violin is far from a natural position and you are holding your arms up for hours on end. People are unaware of how physically grueling it is.”

Players of most musical instruments face at least some risk of repetitive stress injury. Professional musicians or serious students, who play hours a day, are most susceptible.

The problem is that few people have recognized the problem until recently, says Horvath, who was in South Florida recently to work with musicians from the New World Symphony and the University of Miami.

“When I had an injury when I was a student (in the late ’70s) there were pat answers. A doctor or an incredulous layman would say: ‘How can it hurt to play?’ implying it’s all fun and games. ‘They pay you for that? It’s all in your head; you musicians are so sensitive.’ Or, ‘You should try to do something else, change your career.’ For those of us who spent our lifetime practicing, our identity is so wrapped up in the instrument we play it is unimaginable conceiving of doing something else.”

Youths at higher risk

Horvath cites a 1988 study by the International Conference of Symphony and Opera Musicians that found 76 percent of musicians had sustained a career-threatening injury that required a chunk of time off. Musicians ages 35 to 45 were the most likely to report at least one problem (82 percent). The most severe problems hit the youngest musicians.

Why younger?

“The theory is that people are practicing their hardest trying to get into orchestras or they are in orchestras for the first time and are overwhelmed with the responsibilities of learning new repertoire,” Horvath says, noting she has seen children as young as 12 suffering overuse injuries.

Several smaller studies have since been done at the college level, with similar findings.

“It’s pretty common, except people didn’t know what it was,” says Ross Harbaugh, a cello professor at the University of Miami’s Frost School of Music, who has incorporated some of Horvath’s warm-up exercises with his students. “With sports medicine becoming more sophisticated and Janet being this crossover person, it’s possible for people to not have career-ending injuries like carpal tunnel or tendonitis.”

Horvath cites several reasons the number of injuries will increase unless musicians learn to protect themselves early.

“The 100-yard dash for an athlete seemed impossible to do under 10 seconds. Now it’s common,” she said. “Same in music. Younger musicians are playing more difficult repertoire. Orchestras are playing more difficult repertoires that seemed unplayable 50 years ago. Instruments evolve and extend the possibilities. Schedules are crazy. Our (orchestra) plays 52 weeks and we play three to four concerts a week with different music, so we’re always having to practice next week’s music, and conductors like to program blockbusters to bring the audience in.”

Injuries vary

The instruments that are the most awkward to hold yield the highest rate of pain: the violin and viola, for instance.

“The musicians have to hold their left arms in a godawful position and function in a very intricate way with their hands at the same time. That’s asking for trouble,” notes oboe player Patricia Nott, dean of musicians at the New World Symphony.

Cellists, bassists and harpists suffer lower back pain.

“We sit without back support on the edges of our chairs; that takes its toll,” Horvath says.

Then there is clarinetist’s thumb, for supporting the entire weight of the instrument with one digit. Jaw and neck problems are found among flute players. Keyboard players suffer problems with their wrists.

“Playing (less) Hurt,” now in its fourth printing, features 90 stretches for musicians, dos and don’ts lists, a resource list and practicing tips, such as how to warm up properly, how to pace yourself and how often to take breaks.