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.