Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

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There's Nothing Wrong with You- Working with Injury-Shaming in Music

Sometimes, despite all of your best intentions, your body doesn't cooperate.  It may be a repetitive stress injury, an immune response, tendonitis, migraines, the diagnosis of a disease, genetics, or the result of a trauma such as a car or bike accident.  You may have been eating well, sleeping enough, moving, taking your vitamins, and getting regular massages, but sometimes, things go astray and it can be hard to pinpoint how or why.  What then ensues is a series of self-destructive thoughts, such as how will I take that audition? How will I finish the semester?  What about this upcoming concert?  Will I be able to have a career? And so on.  Sometimes, a small injury can quickly escalate to a mental crisis in a matter of minutes, courtesy to your self-inflicted stress, and then the views of those around you only make things worse.  What do I mean exactly by that?

When one is suffering an performance-related injury, the automatic assumption by many administrators and teachers is that the way you play is wrong.  There's something wrong with your setup.  There's something wrong with your habits.  There's something wrong with you. I have been guilty of this thought, but I see it most frequently in academic settings and music festivals.  Here are some of the other classic responses from administrators:

Other people in this orchestra aren't hurt, why are you?

You're only doing this for attention, it can't be that bad.

Play through it, you've got important concerts coming up.

Why now?  You've been fine all year, and now you're hurt?  You have to fulfill your requirements or you won't pass.

The tricky thing with the human body is that everyone is wildly different.  There are certain basic movements that are unsafe for most bodies, and there are many things that are safe for most bodies, but musical training lives mostly in the "in-between" realm.  The truth is that music is a REPETITIVE action, and any repeated/semi-static position has mobility and stability risks of huge proportions!  Here's a great quote from Katy Bowman on this: "The problem is the repetition of stillness, not the position you're in while doing it." 

What often then occurs is a battle of school administration, faculty, medical professionals and students in trying to "get out" of certain commitments.  The counterattack is often ugly, and students are in a shaming crossfire between administrative requirements and personal pain.   Here's one of Brene Brown's TED talks on shame: " this web of unobtainable, conflicting, competing expectations about who we’re supposed to be. And it’s a straight-jacket."

So here are some of my propositions:

1. Let's all acknowledge (musicians, teachers, school administrators, schedulers, festival managers!) that classical music and the practice of all music has musculoskeletal risk.  We expect students, colleagues and musicians to practice or play for 4-6 hours a day, without injury EVER.  (If we asked an athlete to train 4-6 hours a day and never get injured, there might be some major problems, right?)

2. It's not usually safe to play more than six hours a day, and any festival or administrator that makes you or your students feel badly about going into the injury threshold zone is full of &%$#.  Young musicians may be able to bounce back more quickly than older musicians, but they may also have less body awareness and be unaware of when they've played too much or how they feel.

3.  Let's stop institutionalized injury-shaming.  Really.  If someone is truly working with an overuse injury, don't punish them by emphasizing how much school orchestra they have to make up, or putting them in a demoralizing educational situation.  Come up with a better solution to make up the hours.    When I was at conservatory, the "injured" often had to play in the freshman orchestra, in the back of the section, or play the most undesirable concert or concerts.  Talk about a shaming experience!  Maybe it makes more sense for them to be in rehearsal with a score and write a paper on what's going on in rehearsal, and what the ensemble issues are.  Have students go to a conducting class instead.  There are TONS of ways to become a better orchestra musician and fulfill an academic credit that don't rely on playing in orchestra.  Musicians already deal with the fear of "not being good enough" and putting students in a depressing situation doesn't help morale.  (In addition, don't continue punishing students after they've been injured and healed.)

4.  While there are things we can all do to be healthier and have a more tension-free setup, a student's setup is probably not totally wrong.  That's placing a value judgment on a habit, technique, or learned movement, which can be a dangerous mental place to live.  (I've had this crisis through the lens of intonation...I'm doing everything wrong, I'm a terrible person...blah blah blah)  Sometimes a student is doing something in a non-efficient way, but rarely is a motion, movement, or setup inherently wrong.  (High heels, smoking, and rhythmic/pitch inaccuracies can be the exception.)

5.  Sometimes the area of pain is not actually causing the pain.  Someone might be having a wrist/elbow issue, but the problem is the tension in the trapezius.  Or someone is having back pain, but is really having ankle and knee instability. We can't just put a band-aid fix on things without looking at the whole person, and that means everything from walking and sitting to sleeping and purse holding.

6. Let's be open to change as teachers and musicians.  Sports medicine is far ahead of arts medicine in terms of understanding the body, yet few musicians receive any of that valuable insight.  Be open to changing how you teach, how you play, and how you move in your life.  Seek other opinions if you can't help your student.

7.  Be a professional.  The excuse I often heard at music school was, "If this was a professional orchestra, then..." If schools want to be professional incubation zones, then treat students as professionals.  In a professional orchestra or ensemble, there are constraints as to how much rehearsal time a day is allow, and if a member has an injury, they're generally given protection to prevent the loss of their job. They're not generally seen as a pariah or a liar.  At a school, that means there should be accountability for conductors with regards rehearsal time and break time amounts, halfway decent chairs, and consistent policies for injury management.

7. If someone has been injured in the past, don't hold it against them, as though they may be hurt again.  Here's a great quote from Gramophone:

Whereas athletes who have injuries are treated and then expected to rise once again to the top of their game once healed, a previously injured musician is often considered unreliable physically, and doubt remains in the mind of industry leaders. Why is injury accepted, treated and supported in the sports world, yet so shaming and unacceptable in the music world?

8.  Let's acknowledge that everyone's body is different, and that some people may be immune to injury more than others.  It may have to do with the size of your frame, how muscular your are, your genetics, the size of your instrument, which side is dominant, etc.  Rather than seeing an injured person as "weak," "poorly taught," or "wrong," we can begin to change the stigma of overuse injury, illness, and recovery.

Overuse-what is it exactly?

by Kayleigh Miller


Most musicians have experienced some degree of fatigue after a long day of playing, whether it is intensive practicing for a concert or audition, or extensive rehearsals and a long day of school.  The problem is what to do when the discomfort doesn't go away, and that is when general panic ensues.  The thoughts about "my career is over," "I'll never get into ____," "I'll fail my jury," etc. start to percolate, and stress does not help inflammation.  Here are the most basic risk factors.

Overuse causes can be fairly simple:

1. Rapid increase in practicing.  Whether it's going on a holiday before an orchestra festival, and suddenly jumping into 6 hours a day of work or taking on extra rehearsals before a concert, dramatic increase in playing one's instrument can yield immediate pain.

2. Misalignment.  This is a broad category, and alignment and biomechanics are a subject unto themselves, but can refer to one's posture, how one holds an instrument, tension release patterns, instrument setup, or even chairs, shoes, and music stand height.

While either of these two factors may not yield an immediate pain response, over time, there can be damage if left unchecked.  Here are Janet Horvath's "Danger Signals," from her book "Playing Less Hurt," which are signs of a current or future injury risk.

1. Pain and/or burning sensation

2. Fatigue or heaviness.

3. Weakness

4. Impaired dexterity

5. Tingling, numbness.

6. Clumsiness.

7. Stiffness.

8. Involuntary movement.

9. Impaired circulation.

10. Difficulty with normal daily activities.
— Horvath, Janet. Playing (less) Hurt: An Injury Prevention Guide for Musicians. 2nd ed. New York: Hal Leonard, 2010. Kindle. (loc 79- out of 5559)

Regardless of where you fall on the spectrum of overuse, or whether you think you may be at risk, here are some basic suggestions:

1. Take breaks while practicing. I've seen a wide variety of break time suggestions, from a few minutes every thirty minutes of work to ten-fifteen minutes every hour.  Experiment with what works best for you.

2. Warm-up before "going for the gold," so to speak.  Give your muscles a chance to acclimate before pushing them to capacity in rehearsal, personal practice, or under pressure.

3. Evaluate your setup and talk to your teacher, a movement instructor, or an injury specialist to start to look at your personal tension patterning or misalignment tendencies.

4. Start noticing your basic wellness routine: do you sleep consistently?  How's your stress management?  Nutrition? Exercise?  Stretching and strengthening? Where are you contributing to injury in other areas of your life?

While there are many different types of overuse injuries, as well as a wide range of complex contributing factors, these are some basic concepts to help you and your students.

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