Few people will be aware of what it takes to become an orchestral musician, and fewer still will be aware of how hard it is on the body to maintain a professional playing career. Virtually every professional musician will have a story to tell about discomfort, strain or injury related to playing and will know colleagues who have had similar issues. I was discussing this with a principal orchestral player and she went through the address book on her phone and pointed out how many people she knew who had stopped playing altogether due to injury. I suspect that every experienced musician could do this.
Researchers have investigated this issue for many years and they have found that the rates of playing-related musculoskeletal disorders, as they are termed, are the same globally, and, they are getting worse. One group of researchers found that the rate of injury amongst musicians was higher than that found in the construction industry.
In addition to counting how many people are affected, it is important to understand why it is happening, and research into this has been done too.
Why are musicians’ injury rates so high?
Non-musicians that I speak to are astonished that musicians have such problems and then after a moment’s thought, they suggest that it must be the repetition that is the cause. The truth is far more complex and wide-ranging than that, and it may be helpful to examine a few of the issues.
The first, and probably most obvious issue, is that most instruments were designed hundreds of years ago with the primary objective of producing a pleasing sound, with little regard for ergonomic principles of making them easy and comfortable for a person to play. There have been no great ergonomic advances to change the design of any instrument but instead, we now have a vast choice of chin rests, shoulder rests, straps and slings, which are certainly helpful, but don’t get away from the fact that most instruments are awkward to play.
Is it just due to repetitive movement?
All instruments require repetitive movement and some are more demanding of the body than others, sometimes because of the position and sometimes because of the intricacy of the movement. This can be illustrated if we look at how many movements we make when playing. For example, a soloist playing the Bruch Violin Concerto will make approximately 1517 movements with the bowing arm, and 3929 finger movements with the left hand. Add to this the rehearsal and practising time and then multiply this by a week, a month, or a year and this is a demanding activity for the body to perform.
From a clinical perspective, it might be worth noting that we see the left shoulder of upper strings players is in a vulnerable position all the time they are holding the instrument.
Posture
Playing position and posture are leading but sometimes indirect causes of playing-related strain and injury. To move well, we need a stable foundation and good support.
Repertoire
Sometimes, repertoire can be a problem. Some pieces are more demanding than others in their complexity, their duration or perhaps because the piece has a page of tremolo for some unfortunate string section. The challenge may be in the combination of pieces, or that there are two or more difficult combinations over several weeks.
Scheduling
Orchestral scheduling may add to the challenge for a musician. Rehearsing, recording, and performing, sometimes all on the same day, represent a physical challenge since the injury rate in anything relates to the duration of the exposure to the risk.
Nutrition
What we eat plays a surprising role in our physical health and maintaining a good balance of nutrition is complicated and not always easy to accomplish. Touring makes this especially difficult, as does leading a busy life. Many of us resort to quick and cheap sources of carbohydrates, and wheat-based food, which are not necessarily our best sources of healthy nutrition. This affects our physiology way beyond just providing fuel to keep moving. Athletes concentrate on eating well because they understand the way that it contributes to their performance. We should all do this.
Hydration
Hydration does not have an obvious relationship with pain or well-being, but it plays a role in preventing muscles from becoming strained through over-use, and how our physiology performs more generally. Being even slightly dehydrated reduces our ability to concentrate and focus as well as how we respond to endurance physical activity.
Sleep
How long and how well we sleep has a huge influence on our health, and it is our main opportunity to recover and repair. It is also the time that the body resets its chemical and hormonal levels, and gives the mind time to arrange its filing system. Poor sleep patterns can be the origin of other health issues.
Travel
Touring may sound exciting and glamorous but the reality is rather more challenging. Hours waiting at airports, and hours spent sitting on aircraft seating, all potentially done at odd times of the day. Then there is the hotel accommodation where the bed and pillows are never quite as comfortable as our own. Then add the potential for tiredness associated with jet lag. In addition, we never eat quite as healthily when we travel. Of course, not all travel is by air, regional performances often require long coach journeys, and many musicians have to sleep on the coach on the way home after the performance.
Exercise
The research suggests that many musicians do not have the inclination, the energy, or the time to do regular exercise. Physical fitness is vital to maintaining health, especially when one has a physical occupation.
I know many musicians who run, which is a great exercise because you get lots of benefits for the time spent doing it, it is free and can be done anywhere. Indeed, I know a concert pianist who runs marathons (and she has a young daughter and a husband who is a musician). Exercise is a great way to start a day, and it will give you energy, it will help your sleep, and is the best antidote to stress. Running is not the only solution, there is a huge choice of ways to keep active.
Playing an instrument is a physical activity that depends on accuracy and control as well as having the capacity to maintain movement over long periods, and throughout a career. Over time this leads to the overdevelopment of some muscles and the neglect of others. To remain physically healthy, we need to keep all of them in tune, all of the time.
Psychology
One of our greatest enemies can be our minds. Our psychology and beliefs about our health play a huge role in managing the stress and physical nature of being a performer and having to rely on our health to make a living. On the other hand, our mind has a great capacity to be an ally if we have the right tools at our disposal to create a positive mindset.
Genes
Of course, your genetic inheritance may also influence your health. For example, arthritis, many autoimmune diseases, and even headaches and migraines may be passed to you from previous generations. Something that 100% of us inherit is our anatomy. Some of us have less flexibility in our muscles and joints than others and some of us have different dimensions such as limb length. Whilst we cannot do much about what we inherit, we do have some control over our environment and what we choose to do.
Normal life
Life goes on outside the concert hall and the rehearsal room, and many external factors can affect how we play. We still need to shop and cook and do DIY and housework. We may have children, and they operate a different timetable from professional musicians. They may need to be transported, and they will need to be fed, entertained, and helped with homework. Even these things affect our physical health.
How do we manage the discomfort?
Discomfort, pain and injury have become accepted by musicians as a normal element of what they do. What people do when they are in pain is generally a short-term alleviation of the symptoms such as taking painkillers, and this does not address the causes. Indeed, doing the same thing that caused the pain whilst at the same time masking the warning signs can potentially do more harm. This is not a healthy strategy.
Unfortunately, the options for treatment are varied and not always helpful or effective. Few clinicians of any discipline have much insight into the world of the professional musician and those that do are rare. Some treatment simply ameliorates but does not prevent the recurrence of the problem.
What can musicians do?
For the long-term health and well-being of musicians, the profession would benefit from promoting greater awareness and understanding of how important physical health is from an early age. Those employed in music education have a role to play here, and health and well-being ought to be a compulsory part of instrument tuition from the very start, and there is some progress to be made on this front. Orchestras too could make some provision for allowing time to warm up and to do some recovery movements after playing. This would of course require some cultural change.
To say that prevention is better than cure is a cliché and it is true. It is less unpleasant, cheaper and a wise investment of time. It may also improve your sound and protect your career.
To conclude…
The reason why musicians are at high risk of playing-related injury is so much more complex than many of us imagine, it is a complicated suite of variables, all of which contribute. We have control over many of these variables. The wisdom is in knowing what things you can change and then how to change them, then making them a habit.
Musicians in Tune has put together an exercise programme designed especially for each instrument. We also have advice and tips on all the causes we have outlined above. To find out more, have a look at the programmes that we offer here…
