The Importance of Teaching Injury Prevention in Beginning Musicians 1!

The Importance of Teaching Injury Prevention in Beginning Musicians

Lindsey R. Showalter

James Madison University

 The Importance of Teaching Injury Prevention in Beginning Musicians 2!

Abstract

The importance of teaching injury prevention in beginning musicians is a topic that has recently

started to get more attention in the professional world. Although musicians, both students and

teachers, have ignored and misunderstood playing-related injuries, they are real and common.

There are many different types of playing-related injuries including musculoskeletal injuries,

neurological complications, and psychological issues. Many factors contribute to these issues

including external factors such as posture, technique, and environment as well as internal factors

such as physical attributes and psychological stresses. Although these injuries are common

among musicians, they are preventable. It is the music teacher’s responsibility to educate herself

and her students on the causes, symptoms, and prevention of such issues. This process begins at

the very start of a student’s music education and continues throughout their entire musical career.
 The Importance of Teaching Injury Prevention in Beginning Musicians 3!

Playing a musical instrument, whether as a professional performer, as a student looking to round

out his or her extracurriculars, or as a hobby, can transport both musician and audience to other

worlds. However, this special experience can be shattered by the pain of a playing-related injury.

Music-related injuries are a reality that until recently, musicians and doctors both chose to-for the

most part- ignore. Music-related injuries can range anywhere from requiring an hour of rest in

between playing sessions to career-ending incidents. These injuries are real and the chance that

they could happen to any musician is high. The International Conference of Symphony Orchestra

Musicians conducted a survey and found that “seventy-six percent of respondents had

experienced a serious injury during their careers that required time off from

performing” (Horvath, 2010, p. 7). The best way to avoid these injuries is prevention which

starts with the teacher in the very first lesson a musician receives.

There are many reasons musicians may choose to ignore pain when playing their

instruments. Often, musicians think that if they are in pain, they must be doing something right-

that if they aren’t at least a little sore, they’re not working hard enough. This is an extremely

dangerous idea to hold. The saying “no pain, no gain” does not always apply. Other times,

musicians can be determined to play through the pain to impress their teacher, parents, or peers.

A large number of teachers may be unaware themselves of how common playing-related injuries

are and may encourage their students to keep playing and that the pain will eventually go away.

Even if the teachers do recognize that something is wrong, they may not know how to fix the

problem. Another reason not to seek help with injuries is the fear that treatment will alter the

musician’s life in some way. The musician will have to alter their own technique, playing
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posture, the instrument itself, or possibly take a long period of time off of playing their

instrument, which could result in job loss. Ignoring the pain that is signaling a playing-related

injury can be detrimental to the musician’s future. Even if the musician is able to adjust and

continue playing in pain, it is possible that the injury will cause more problems in the future

(Otswald, Baron, Byl, and Wilson, 1994, p. 50).

There is a large variety of factors that can cause pain and playing-related injuries in

musicians. Some musicians experience pain that is caused by genetic conditions. Hyper mobility,

also known as double-jointedness is not uncommon and can cause strain on the joints in the

hand, as the musician has to compensate for the extra loose ligaments (Dawson, 2006, p. 37-38).

This mostly happens by squeezing too hard in an effort to control the joints. It is important to

remember that every body is different and that some bodies may not be as compatible with some

instruments. For example, a smaller musician will have to stretch farther to play larger

instruments such as the tuba or string bass. Other contributing factors include the musicians’

techniques and the environment in which they are playing (Quarrier, 1993, p. 93). The best way

to prevent music-related injuries is to maintain the most natural body position when play an

instrument. The actions and positions required to play most musical instruments are not natural

for the body, yet musicians spend extended amounts of time performing these unnatural tasks.

Not only is the act of playing the instrument awkward, but carrying and supporting the

instrument also take a toll on the musician’s body. When musicians experience pain, they adjust

their posture or technique to relieve the pain, sometimes compromising their proper positioning,

leading to even more injuries (Bellisle and Decker, 2017, p. 2). If musicians started off with poor

posture or technique, they would likely begin to experience pain. They would then make an
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adjustment to alleviate the pain, resulting in worse technique, and therefore perpetuating a

vicious cycle. Environmental issues also contribute to injuries. Often times musicians have to

perform in cramped spaces that do not allow them to sit with good posture, move freely to play

their instruments, or be positioned in a way that they can easily see the conductor. All of these

issues can result in muscle strain and fatigue (Quarrier, 1993, p. 93). Additionally, dim lighting

and poorly copied music can cause strain on the eyes and repeated exposure to loud noises can

result in hearing loss (Otswald, Baron, Byl, and Wilson, 1994, p. 51). While these injuries may

not be as quickly recognized as musculoskeletal injuries, they are still important to be aware of

and prevented.

There are many different types of injuries and conditions that can result from playing a

musical instrument. Most injuries are related to the musculoskeletal system in the head/neck,

shoulders/back, hands, and wrists (Foxman and Burgel, 2006, p. 310). Musculoskeletal injuries

can be difficult to detect, but it is important to always be aware of the possibility of their

presence. Doctors often refer to these injuries as overuse injuries. “Overuse is a loose term

applied to several conditions in which the body tissues have been stressed beyond their

biological limits. These disorders of the musculoskeletal system can affect bones, joints, and soft

tissues such as ligaments, tendons, and muscles (Horvath, 2010, p. 11). The whole basis of

playing a musical instrument revolves around repeated unnatural movements for extended

periods of time. These movements, especially when combined with any technical, physical, or

psychological complications repeated extensively bring about these injuries. Repetitive strain

injuries are a category of overuse injuries. Strains refer to the muscle-tendon units, and sprains

refer to the ligament (Horvath, 2010, p. 11). These are caused by tears or inflammation in the soft
 The Importance of Teaching Injury Prevention in Beginning Musicians 6!

tissues. Another common overuse injury is tendinitis, inflammation of the tendon or its gliding

coverings (Dawson, 2006, p. 38).

While slightly less common, neurological issues are also potential injuries for musicians

to experience. These issues can result in “loss of sensation an eventual interference with motor

control” (Otswald, Baron, Byl, and Wilson, 1994, p. 50). Focal dystonia and nerve entrapment

are two examples of neurological issues. Focal dystonia is a common and dangerous

complication for musicians. It is defined as “an involuntary motor movement or occupational

cramp limited to an activity such as playing an instrument (Foxman and Burgel, 2006, p. 310).

Musicians who are diagnosed with focal dystonia may have trouble with speed, accuracy, and

coordination when playing their instruments. Nerve entrapment causes carpel tunnel and cubital

tunnel syndrome. This happens when fats fluids build up in narrow spaces of the joints, and

when musicians spend long periods of time in positions with the joints at end ranges (Otswald,

Baron, Byl, and Wilson, 1994, p. 51).

Music-related injuries are not always physical. Musicians are under a lot of stress not

only as professionals, but as students as well. As a professional performer, playing a musical

instrument can be one’s main source of income. Not only is that musician expected to perform

flawlessly because the audience expects her to, but she is relying on herself to provide that

income. Similarly, students feel pressure to perform well for their teachers. Whether the student

is a beginning player or studying to become a professional, well-meaning teachers can be a large

factor in inducing performance anxiety. While playing an instrument can be the best part of a

musician’s day, the moment there are other people in the room, the musician can feel totally

petrified. Along with performance anxiety, depression often affects musicians for various reasons
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(Otswald, Baron, Byl, and Wilson, 1994, p. 51). Every person experiences failure in some way

during their life, and in the musical world, some failures can seem catastrophic. In a profession

where a musician might take a dozen or more auditions before being offered a job, the stress

level is quite high as well as expectations for themselves.

Fortunately, there are ways to prevent these music-related injuries from ever occurring,

and they start with a musician’s very first teacher. It is critical that teachers begin instructing

their students in injury prevention from the moment they pick up their instruments. According to

Barrett, (2006), music educators “need to begin addressing injury prevention from the fort lesson

in elementary school and continuing through the significant changes of middle and high school

students.” Students, especially those who start young, will be growing and their bodies changing

throughout the process of learning an instrument.

It is logical that the first task a student learns is how to hold the instrument, which

requires knowledge of correct posture and positioning. This is where injury prevention begins. In

order for music teachers to teach injury prevention techniques, the teachers themselves must be

knowledgeable and open about such topics. The teacher should create an open and welcoming

environment where students are not afraid to bring up issues of pain and discomfort when

playing and commit to be a life-long learner in these subjects. There are a plethora of resources

available for both student and teacher to learn about injury prevention including reading articles,

attending conferences, and taking classes in the Alexander Technique.

The Alexander Technique was developed by F. M. Alexander, a vocalist, when he started

having vocal problems that his doctor could not identify. In short, Alexander set out to solve his

own problems and through self-discovery made many observations about the human body and
 The Importance of Teaching Injury Prevention in Beginning Musicians 8!

created a set of principles now know as the Alexander Technique (Kleinman and Buckoke, 2013,

p. 16). Musicians can use the Technique to relate how their bodies work in everyday situations to

how they work when playing a musical instrument. The main point of the Technique is to teach

us to “choose how we react to whatever happens in our lives, consciously rather than

automatically. This helps us develop the possibility of being present, creative, and spontaneous

when we might have otherwise lived, practiced, and performed habitually” (Kleinman and

Buckoke, 2013, p. 19). One aspect of the Technique is body mapping. Kinesthesia, the “sixth

sense” of body awareness, has led to the formation of the concept of body mapping. According to

Barrett (2006), “the goal of body mapping teachers is to prevent injuries through the practical

application of anatomy to musical performance.” In other words, being aware of the functions

and inner workings of one’s own body can help musicians connect to how their bodies function

when playing their instruments. This helps musicians know when something is going wrong,

what is causing the issue, and how to fix it. Additionally, it is beneficial for musicians to know

how their bodies relate to the position of the instrument itself. Even though musicians may feel at

times that they are “one with their instruments,” this is not actually the case, and can cause issues

to think this way (Barrett, 2006, p. 4).

Other practical ways to prevent playing-related injuries relate to how musicians practice.

The practice routine can be an important aspect of preventing injury. When practicing, musicians

need to take regular breaks after playing for a maximum of 40 minutes. Practice breaks should be

at least 5 minutes long and include mental breaks from the music as well (Dawson, 2006, p. 41).

It is also necessary that technically difficult or taxing excerpts not be worked on extensively for
 The Importance of Teaching Injury Prevention in Beginning Musicians 9!

long periods of time and musicians take adequate time to warm up sand prepare their bodies for

playing.

The external factors of playing an instrument are important considerations as well.

Musicians should practice and perform with all of the necessary equipment and space to play

with correct posture and technique to minimize strain. For example, music stands should be

placed in a way where there is a clear line of sight from musician to music and conductor and

seats should be adjusted so that the musicians do not have to assume uncomfortable or unnatural

positions to play their instruments (Dawson, 2006, p. 41). It is also essential for musicians to

have proper seating that supports them so that the instrument can be played with good posture,

reducing the risk of musical strain (Foxman and Burgel, 2006, p. 313). Instrument modifications

can be made such as key extensions, neck straps, chin rests, and stands to achieve neutral posture

(Foxman and Burgel, 2006, p. 313-314).

Future research should be conducted on the effectiveness of teaching injury prevention. It

would be interesting to see if there is a difference between students knowing that their practices

are for the purpose of injury prevention and students who are taught these techniques without

learning their main purpose. A study could be done on three groups of students; one set of

students who were educated in common injuries and causes and practiced injury prevention

techniques, one set who were not educated in injuries and causes, but practiced injury prevention

techniques as part of a daily routine, and a third set who were not educated and did not practice

these techniques. It would be interesting to see if simply being aware of the possibility of injury

made a difference in students’ attention to prevention techniques. In connection to the Alexander

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Technique, is the mind enough to make a difference in the probability, or can simply doing the

appropriate actions be enough?

In summary, all of the previously described techniques for music-related injury

prevention should be used by all musicians. The process of injury prevention beings on a

student’s first day of music education and is guided by the music teacher. As per Kleinman and

Buckoke (2013) “no musician would damage their instrument on a daily basis and expect it to

work well, but some of us misuse our body and apparently expect it to keep on producing good

results for a lifetime.” Musicians must take care of their bodies in order to continue doing what

they love- their bodies are instruments themselves.

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References

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