How can poor health be avoided as a musician?

Musicians are a group of people who have come to accept pain and discomfort as a part of playing an instrument. As I know from my own experience, finishing a day of good practising means back pain or pain after lots of pressure in the right index finger. I am not the only musician who thinks the harder the work, the more exhaustion and the greater success. 

The ergonomic relationship between a player and the instrument is one-sided: the musician adapt to his/her instrument and not the other way around. Apparently, when Nicolo Paganinis skeleton was dug up, his left shoulder was several inches higher than the right after supporting his violin for so many years. 

 Dr. B Ramazzini* wrote in 1713 that «No sort of exercise is so healthful or harmless that it does not cause serious disorders when overdone». Overuse injuries is not a new phenomenon.

 Overuse is a term to describe when the body tissues have been overworked and stressed beyond their biological limits. The repetitive motion when combined with poor posture, force and stress can lead to overuse injuries. The pain that may arise when overplaying is the nerves which is compressed or muscles which have been strained. As well as pain being experienced while playing, the muscles may feel swollen, tight and heavier than usual. To recover from overwork, the muscles needs rest. 

What are the danger signals that musicians have to be aware of?

Pain, fatigue or heaviness, weakness, tingling, numbness, clumsiness, stiffness, involuntary movement, impaired circulation, difficulty with normal daily activities.

If we start to look at musicians' habits in daily life, with and without the instrument, some might find simple ways to avoid some of the most common injuries. For example the way we like and need our bed to be to have a good night's sleep differs from the size and shapes of the body. It is not necessarily right to have a firm bed for everyone, and especially for women it might be better with a softer mattress to support the body shape. It doesn’t matter how someone like to sleep as long as they wake up rested and without pain. 

The important thing with pillows is that you have to make sure it is supporting your neck. Sitting position and standing while bent forward makes the low back discs 50 percent more stressed than standing up straight. People who sit like this for many hours a day are stressing their low backs far more than those who stand and walk about. A way to recover the spine after sitting a lot during a day, can be to lay on the stomach while using the elbows to be able have their backs curved backwards. Musicians should sit as little as possible and move, walk or lie down to rest. The best thing would be to stand to play whenever possible and take the weight off from one foot to the other. Since musicians do have to sit at some point it is crucial to have the right chair. The knees should be lower than the hips and it is very useful to have a cushion which is higher in the back than the front. It is also possible to put blocks on the back legs of the chair. 

One of the biggest difficulties facing the orchestra player is having to sit down and play. The possibilities to prevent injuries may simply lay in providing the best chair. As for the string players who have to share a stand, it would be very useful with a rotatable chair. As one of the first sign of injury happens unnoticed, it is important to be especially aware of how the body should feel like when playing. There might be a feeling of pain in the middle of a performance when it almost impossible to stop playing, but this is the time where it would be most useful to stop and rest. 

An interesting phenomenon were documented by sports psychologists:

 «Muscular endurance and tolerance of fatigue related pain were enhanced when a physical task was performed conjointly with others as compared to solo performance»

 (The Athletic musician, Scarecrow press 1997, page 154)

Incorrect lifting techniques are responsible for many neck and back injuries. Lifting quite small weights like groceries, small children and instrument cases makes most people hurt frequently. Lifting is done by bending the hips or the knees or both but never the spine. To protect your neck while lifting an object, lift your head before you do the lift and make it face straight forward.

 In what way can musicians prevent injuries when playing and practising?

In order to play healthier and better, it is very important with a proper warm-up. Warming up is just as important for a musicians as it is for an athlete. The instrument is not needed for the warm up until the body is warm. This means the body needs to move. As the body gets warmed up, the blood circulates and delivers oxygen to the cells in a quicker amount of time. By increasing the circulation, waste products are excreted more efficiently which makes the body less likely to get injured. The bones slide on each other with greater ease which makes it much easier to move and play.

Stretching is a way of maintain the length and flexibility that musicians need to perform at their best. This is especially important since the muscles begin to loose their elasticity after the age of 30.

Jane Horvath gives a few advises about how to stretch in «Playing (less) hurt»:

Don’t bounce. 

Never stretch to the point of pain, if you are, then you are over stretching. 

Use slow pressure.

Keep breathing.

Relax as you hold the stretch

The music stand should be positioned by the level of the eyes with the centre of the page. Many musicians get neck problems because their stands are too low. In orchestra, the stand has to be lower than eye level to be able to look at the conductor so to compensate, neck exercises would be very useful. 

Adding wheels to an instrument case might be the solution to a very heavy case which demands extra energy for everyday carrying. 

Some musicians experience muscle imbalances which may occur over years of asymmetrical postures. The overactive muscles may become sore at the same time as the surrounding muscles become weaker. And injury rates are directly related to fitness levels (J. Horvath, Playing (less) hurt, 2010). Once the muscles are injured they need time to heal. Just to play again after an injury is exercise enough for the healing muscles. To correct muscle imbalances, one can lengthening overactive muscles and strengthening under active muscles, build up strength in the less active muscles for a better stability and correct misuse on the instrument. 

Hearing loss is one of the very few permanent overuse injuries. It is one of the most important things to keep safe as musicians would be unemployed without being able to hear and it would also have a very negative affect on their life outside of work. Preventing hearing loss is to be aware of the dangers we are exposed to and be very precocious. Workplaces are the most common source of hearing loss. Orchestral musicians are exposed to high levels of noise. The greatest noise exposure comes from your own instrument while practising or playing with other people. To prevent hearing loss, musicians can: wear hearing protection, practise more softly, use plexiglass shields in orchestras and turn down volumes.

As stress increases, the body feels as though it is under attack. Our practice and performance is affected because our physical and mental coping mechanisms become compromised when stressed. Stress may sometimes come when we are completely unaware. As one get overwhelmed by stress, the shoulders may tighten, the chest tightens, and stomach may cramp. The heart beats faster and we shake or sweat. These physical reactions does not help musicians to a healthier life but there are ways to avoid them by using mental exercise to diminish the physical stress that the body experience. 

There are treatments such as massage, acupuncture, dietary changes, reflexology and vitamins may give short-term pain relief. However, they may not provide a cure for an injury caused by muscle imbalance and overwork. 

After a case study of three performing instrumentalists (Dommerholt, 2009) it was found how physiotherapists has an important role in prevention, diagnosis and management of performance-related injuries of musicians. The case study showed three instrumentalists (a college student bassoon player, an amateur guitarist and a professional organist) with a high level of pain in the index finger, the wrist and the thumb. They were all in habits of playing their instrument with a bad posture, adjusting to an instrument which didn’t «fit» in the hand and practising for several hours without a break. They could not play their instrument more then 5 minutes before they could felt high level of pain. As they arrived with the physiotherapist the case reports showed how the patients sometimes might not have the right medical diagnosis. The organist was almost exposed for surgical operation on her injury which were not the solution she needed to get well. The guitarist was diagnosed with «scar tissue» when he actually had a myofascial pain** and dysfunction.

The article also points out how performance-related injuries are almost always preventable. 

Physiotherapists can educate musicians, music students, teacher, and managers of performing arts organisations, which has been shown to be very effective (Dommerholt and Norris, 1997; Hildebrandt and Nubling, 2004.)

It is not a new phenomenon how overuse injuries affects musicians. In fact, it is actually so many that it is unusual for musicians to not have at least one medical problem. Musicians need to stop ignore the demands playing makes on the body and stop accepting pain as a part of music making. It is also important to seek help no matter how paranoid musicians get to loose a job or get a «bad reputation» over it. And when musicians do go to seek help, it is very important to get help and advice from the right people and get the proper diagnosis to the problem. 

Musicians are musical athletes and need to look after their bodies and avoid playing injuries. Athletes and musicians suffer from some of the same types of injuries as musicians place huge demands upon their bodies practising for many hours towards excellence. 

Compared to athletes, who have one person whose job is to make sure that they are generally fit and in good physical condition, musicians have no one to look after their bodies, other than themselves. Musicians learn to play without any support on how to prevent injuries as their teachers have little knowledge of how to protect the body from overuse injuries. Children, students and professional musicians needs to be aware of the dangers and be aware when the body hurt because that is the way to know that the body is out of balance. 

Footnotes

* the founder of industrial medicine over two centuries ago (1633-1714)

** pain disorder that affects the muscles and fascia throughout your body. Fascia is like a web that surrounds the bones, tissues, organs, and blood vessels throughout the body. Myofascial pain syndrome can attack and cause degeneration of certain areas of the fascia, resulting in chronic pain and a variety of other symptoms