Health, Safety, and Injury Prevention for Musicians

Hearing Health.1-2
Woodwinds3
Brass.. 3
Percussion..4
Voice.. 5
Piano.. 6
Strings7-8

Healthy Musicianship
Hearing Health
Music making requires physical, mental, and emotional wellness. A critical component
of physical health for all musicians is the ability to hear well. According to the 2012
Beloit survey of entering college students, 20% of all college freshmen arrive on campus
with some noise-induced hearing loss (NIHL). A good rule of thumb is to avoid noises
that are too loud and too close or that last too long. Long or repeated exposure to
sounds at or above intensity levels of 85 decibels can cause hearing loss. The louder the
sound, the shorter the time period before NIHL can occur. Although being aware of
decibel levels is an important factor in protecting ones hearing, distance from the source
of the sound and duration of exposure to the sound are equally important. Hearing loss
and tinnitus (ringing or roaring in the ears or head) may be experienced in one or both
ears, and tinnitus may continue constantly or occasionally throughout a lifetime.
The good news is that NIHL is 100 percent preventable. All musicians should
understand the hazards of noise and how to practice good hearing health. To protect your
hearing:
Know which noises can cause damage (those at or above 85 decibels). Download
a decibel meter app for your hand-held device and refer to it in noisy situations.
Wear earplugs or other hearing protective devices when involved in sustained
loud activity (special earplugs for musicians are available).
Rehearse in spaces with a large cubic volume for sound waves to move without
being too close. Also be aware of the direction of the sound source too avoid
sounds too close to one ear or the other.
Temporary hearing loss is called a temporary threshold shift. After any sound
exposure that causes ringing or roaring in the ears, allow 16 to 48 hours of quiet
for the ears to recover.
If you suspect hearing loss, have a medical examination by an otolaryngologist (a
physician who specializes in diseases of the ears, nose, throat, head, and neck)
and a hearing test by an audiologist (a health professional trained to measure and
help individuals deal with hearing loss).

To learn more about hearing health, refer to the National Institutes of Health
(http://www.nidcd.nih.gov/health/hearing/pages/noise.aspx) or Audiology Online. For
information regarding wellness issues relevant to specific instruments, including the
voice, consult with your private teacher.
Additional sources to reference include:
This link is for a new earplug for musicians
http://hearinghealthmatters.org/hearthemusic/2012/a-neat-new-earplug-for-musicians/
ezine on hearing health
http://hearinghealthmatters.org/
Clark Audiology & Hearing Center
http://www.betterhearinghealth.com/musicians-and-hearing-loss.html
audiology online
http://www.audiologyonline.com/articles/article_detail.asp?article_id=1936
WELLNESS SOURCES
Texts
The Musicians Way: A Guide to Practice, Performance, and Wellness by Gerald
Klickstein
Playing Less Hurt: An Injury Prevention Guide for Musicians by Janet Horvath
Musicians Yoga: A Guide To Practice Performance and Inspiration by Mia Olson
The Artist's Way. by Klickstein, Gerald.
The Musician's Body: A Maintenance Manual for Peak Performance by Rosset i Llobet,
Jaume, and George Odam.
The Biology of Musical Performance and Performance-Related Injury by Alan Watson
On-line Sources
Musicians Wellness Initiative
College of Music, university of Colorado Boulder
Music.colorado.edu/departments/wellness
(somatic training, health-related information, medical support network)
Voice Care Network
Yamaha Music and Wellness Institute
www.yamahainstitute.org

Woodwinds
In order to help prevent injuries specific to the woodwind instruments, knowledge from
qualified professionals and authoritative medical sources regarding professional health
issues and the prevention of performance injuries, and to gain access to such
professionals for treatment, are available online. Some of these websites include:
Playing Related Musculoskeletal Disorders in Woodwind, Brass and Percussion Players:
www.jhse.ua.es/jhse/article/view/91Used Woodwind and Brass Musical Instruments
Harbor Harmful Bacteria and Fungi
www.yournaturalhealth.com/natural_health_news/2011/03/used-woodwind-andbrass-musica.html
Common Musculoskeletal Problems in the Performing Artist
www.med.nyu.edu/pmr/residency/resources/PMR%20clinics%20NA/PMR%20clini
cs%20NA_performing%20arts%20medicine/MSK%20problems%20in%20perfor
ming%20artists.pdf
Music Students Health Problems and Health-promoting Behaviours
http://music.unt.edu/pianoresearch/reference/Kreutz.pdf
These websites help make distinctions between the provision of general musicians health
information in the music program and the specific treatment of individuals by licensed
medical professionals.
In order to documenting compliance, individual course syllabi will include this discussion
of woodwind health issues.

Brass
Trumpet (brass instrument) playing can contribute to good physical and mental health
(Hickman). Proper playing habits can benefit mental, cardiovascular, and psychological
health; however, improper playing techniques can potentially lead to medical problems
such as hernias, torn muscles, temporomandibular joint pain, hearing loss, and other
conditions.
The above maladies, and others like them, are rare among trumpet (brass) players;
however, these conditions, their causes and remedies (where available), will be discussed
during studio class as a unit within the pedagogy component of applied lessons.
Information pertaining to medical conditions affecting trumpet (and brass) playing,
including a section devoted to clinical help for musicians and recommended readings,
may be found in Trumpet Pedagogy: A Compendium of Modern Teaching Techniques by
David Hickman [Chandler, Arizona: Hickman Music Editions, 2006, pp. 233-256]
Additional information for brass players may be found at:
http://www.musicandhealth.co.uk/health.html
www.methodisthealth.com/arts

Percussion
Research in the Feild of medical problems of the performing percussionist has
increased a great deal in recent years.
Today there are a number of resources available to the injured
percussionist/performer. The challenge is to become more aware of injury
prevention before it occurs.
The two most common injuries in performers of all instruments, is hearing loss
and upper extremity injuries. Hearing loss in a percussion performer is
directly a threat to their ability to perform. Upper extremity injury is very
common in musicians. The causes of these injuries are usually muscle overuse,
poor ergonomics, poor body mechanics and poor overall fitness.
Three articles/resources that deal with Injury to the Percussionist, and
remedies (and awareness) include:
May, David Warren. Injury Prevention in Percussion. Indianapolis, Indiana:
Percussive Notes. April 1994, pgs. 730 75.
Haley, Terri L. Percussionists' Common Back Injuries. Indianapolis, Indiana:
Percussive Notes. April 2000, pgs. 60-65.
Haley, Terri L. The Athletic Percussionist: Conditioning and Injury
Prevention. Indianapolis, Indiana: Percussive Notes, October 2006. pgs. 80-82.
www.pas.org/members

Voice
Vocal Health is an imperative for the physiological maintenance and function of the
singing voice. Teachers of voice encourage healthy singing through proper usage as
well as attention to general health. Students are encouraged to act as an athlete in
training attending to warm-ups prescribed by teachers and conditioning the voice as a
muscle. However sickness, overuse, and other factors - both physical and environmental
can have negative impacts on vocal function. Resulting maladies can be temporary in
nature or more severe, resulting in lengthy voice rest and therapy. The National Center
for Voice and Speech has designed a website (www.ncvs.org) to help inform singers of
laryngeal function (www.ncvs.org/products_tutorial.html) and also how to take care of
ones voice (www.ncvs.org/products_health.html). Examining ones vocal function and
habits is vital to consistent usage and longevity .

Piano
In order to help avoid injury when practicing, it is always important to stretch and warm
up before practicing. A few examples of appropriate stretches for pianists can be found
at the following site:
http://www.musicianshealth.com/stretches.htm
Remember, if something hurts when you are stretching (or practicing), STOP! Stretch
slowly and gently; each stretch should last about 15-20 seconds. These stretches are only
a few examples; more can be found in piano technique textbooks readily available in the
library or music stores.
After stretching, it is important to warm up with a relaxed approach to the keyboard
(which we will discuss in detail during our lessons, practicum, and performance classes).
The use of scales, arpeggios, chords, and specific technical exercises can be used to
sufficiently warm up the muscles required for playing the piano. However, it is
imperative that one remains relaxed in the shoulders, elbows, and wrist and retains a
natural hand shape when playing. Listening to the quality of the sound as well as being
aware of one's body is important and will help to develop a relaxed approach.
Finally, while it is suggested to practice around four hours daily (for performance
majors), this does not mean that it should be done all at once! When a practice session
starts to become frustrating or tiring, take a short break -- the mind and body needs to
rest. And, if pain occurs during a session, take an extended break and focus more on a
relaxed approach when returning to the piano.

Strings
Playing a string instrument means long hours holding a piece of wood, and pressing
down metal strings with our left hand while drawing another piece of wood back and
forth with our right hand/arm. Sometimes we stand when we practice /
rehearse/perform, other times we sit. We all have different physical body shapes and
sizes - for example: 1) we are all physically measure a different height; 2) we each have a
different left hand expanse; 3) we each have a different length of neck; 4) we each have a
different length of our arms, etc We are all individuals!
Additionally, as string players, many of us began playing our instrument when we were
very young: for some of us, we were playing our instrument before we could print our
own name! We have been physically doing things in our playing that we do out of
years (perhaps decades) of habit. Upon entering our collegiate years, because of
curriculum and commitment, we are required to spend many additional hours physically
with the instrument. This often results in soreness, aches all potentially leading to
injury. Sometimes debilitating and career-ending injuries, including repetitive stress
injury (RSI), and focal dystonia.
For these and other reasons, it is imperative that you take the time to understand, address
and correct the proper playing technique for your instrument. Your applied teacher will
help direct you with this. Prevention of injury is vital. Your mental and physical
approach to your instrument: your proper physical alignment and set-up is absolutely
imperative, so that you are using your body as efficiently as possible. Our bodies are our
instruments!
Top tips for efforts towards eliminating injuries:
Study your technique. Compare/contrast to the technique of world-class artists.
Read method books.
Practice away from your instrument. MUCH practice can be accomplished
AWAY from your instrument mentally.
LISTEN to recordings of world-class artists and study.
If you are feeling any pain: STOP!
Dance! Ballet / Modern / Pilates / Alexander technique, etc All of these (and
more!) are incredibly helpful to understanding how your body moves which is
at the core of your concept and approach (both physical and mental) of playing
your instrument.
Film yourself when you practice. Watch the film. Compare/contrast your
technique with that of world-class artists.
Warm up appropriately.
Vary your practice routine.
Eat well. Get appropriate rest. Get physical exercise. Stay fit.
Establish an efficient practice routine. Take breaks every hour in order to rest
your body.

There is an enormous amount of interest and research in reducing / eliminating /

rehabilitating performance injuries available electronically. Your applied teacher can
help direct you to applicable articles / websites, and also with improving your postural
set-up and technique. Research your interest on the internet: (ex: violin injuries; viola
injuries; cello injuries; double bass injuries).
Furthermore, please ask your applied professor for suggestions for appropriate readings.
For example, excellent resources include the following book titles: Horvath: Playing
Less Hurt; Galamian: Principles of Violin Playing and Teaching.
Lastly, there are national physicians who specialize in the complexity and individuality of
musicians injuries.