Whilst this may seem to be a rather negative title for a blog post it is a pointed reminder that many musicians are spending their careers in a degree of discomfort or pain, which can in time, lead to injury and having to stop playing. It is a topic that is not really at the forefront of conversation in the world of music education and whilst some musicians may discuss it amongst themselves, many choose to keep quiet about it for fear of it affecting their employment prospects. As one friend of mine put it ‘it is the elephant in the auditorium’.
Is it a widespread problem?
The research evidence would suggest that it is a widespread problem, and there is plenty of research. Type the word ‘musicians’ into a medical research database which gives access to 33 million references and, (at the time of writing) there are 3844 results. Indeed, this is a growing area of interest; in the 1990s there were about 30 articles published each year and in the 2020s there are over 250 articles annually. As an aside, it might be interesting to note that if you type ‘sport’ into the database it will return 395,511 results, of which almost 40,000 were published in 2021.
Research comes in different forms and there is a spectrum of quality, but there is one approach that is helpful and is ranked as being of high value in determining scientific knowledge, and that is the systematic review. This is where a group of researchers look at all the references they can find on a particular topic and they take the good quality ones and compare them, in order to come up with a consensus of opinion.
One such study was conducted in 1998 and published in the Canadian Medical Association Journal which was titled ‘Playing-related Musculoskeletal Disorders in Musicians: a systematic review of incidence and prevalence’.1 It was published by Christine Zaza and is a paper that has been cited by almost every study conducted on musicians’ injuries ever since. Zaza looked at research databases for the period 1980 to 1996 and found seven eligible studies. These studies looked at professional musicians as well as those in universities, conservatoires and secondary schools and found that the prevalence in adults of playing-related musculoskeletal disorders ranged from 39% to 87%, and from 34% to 62% in secondary school music students.
In 2015, another group of researchers, this time from the Netherlands brought things up to date and reviewed the literature again2, this time looking at the 20 years or so that had elapsed since the first review, and this time they found that the prevalence had become 41 to 93%. The takeaway from this is that the situation is getting worse.
Studies looking at other occupations generally place construction workers at a prevalence of around 60%.
Looking at the numbers only tells part of the story, let’s look at what else we know from all the research.
The rates of injury are virtually the same in every orchestra around the world.
Female musicians tend to have higher rates of injury than male musicians, they report higher levels of pain, and they tend to get problems that last for longer.
The section that has the highest rates of injury is upper strings, and brass is the lowest.
We know the age profile of who gets injuries and we know that students at conservatoires have just as many injuries as professional orchestral players.
We also know where, anatomically, the injuries occur.
There are articles published on the mental health of musicians, their prevalence of eating disorders, how many do some exercise, their rates of obesity, and more. Indeed, we now have a reasonably good overview of the health of musicians.
Something that catches my eye with almost every paper published on the topic of the physical health of musicians is a line in the conclusion that invariably states ‘…and more research is needed on this topic’. I am a clinician with almost 25 years of experience, I have treated hundreds of musicians and I have read the research. My feeling is that we could spend another 30 years admiring the problem, or we could develop strategies to prevent it. A solution is what Musicians In Tune has put together, specifically for musicians.
References
- Zaza C. Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence. CMAJ. 1998 Apr 21;158(8):1019-25. PMID: 9580730; PMCID: PMC1229223.
- Kok LM, Huisstede BM, Voorn VM, Schoones JW, Nelissen RG. The occurrence of musculoskeletal complaints among professional musicians: a systematic review. Int Arch Occup Environ Health. 2016 Apr;89(3):373-96. doi: 10.1007/s00420-015-1090-6. Epub 2015 Nov 12. PMID: 26563718; PMCID: PMC4786597.
