“One good thing about music, when it hits you, you feel no pain.”
Bob Marley
Growing up in Kingston, Bob Marley experienced the poverty and desperation that was to underpin these lyrics from the song ‘Trench Town Rock’. The line quoted celebrates the capacity of music to sweep you up out of everyday worries and pain and carry you to another, better place. For some people who work in the professional world of music however, it is music making itself that may be the cause of pain.
The occupational health of musicians has been examined in several studies over past years. The figures emerging from these studies are that up to 93% of musicians can experience pain due to playing their instrument.
Many previous studies have looked at musculoskeletal health as a major contributing factor. As musicians we do some of the most highly refined and complex moving done by humans, requiring thousands of hours of training. Professional musicians also routinely expect, and are expected, to continue to play long into our middle and older age. Think of Menuhin and Casals still playing strong into their eighties! So what of the potential impact on quality of life from all those years of bringing music to life for others?
In an interview on Radio National’s Body Sphere program in 2014, titled “Fit to play: musicians and their bodies”, a young music student cites awareness of movement problems as “half the battle”. Another wonders if it is “actually possible to play without injuring yourself whilst ticking all the boxes of a modern performer”.
The comment resonates with how we, as musicians, evaluate playing-related physical problems. Do we view these as inevitable by-products of our chosen profession? How deeply are these problems impacting our studies, careers and lives?
Earlier this year I wrote “The Pain and Discomfort Survey for Musicians” for Body Mapping Australia to find out more. AUSTA members took part, along with a wider community of musical performers of all ages, both professional and amateur, including all instruments and genres.
The scope of previous formal studies done both here in Australia and overseas has often been larger and many surveys have targeted particular groups – professional or tertiary level musicians, school age students, stage and pit orchestral musicians or specific instrumentalists. Environmental, hearing and mental health has been included by some in their focus.
In contrast the BMA survey’s fifty-seven participants had varying backgrounds and their playing experience ranged widely – between just three through to sixty years. Respondents represented staff and students of different conservatoriums, members of instrumental and vocal ensembles, beginners through to professionals. The BMA questionnaire addressed playing-related discomfort and movement and the results are quite consistent with those of previous studies with 96% of respondents experiencing some level of discomfort while playing their instrument or singing. For a third of participants, that experience is frequent or constant while engaged in making music.
Intensity of discomfort, registered on a scale from none (1) to high (5), was rated at level 3 by 39% of survey participants, while 23% scored their pain as high intensity at level 4 or 5.
The majority of respondents experience problems in their neck and shoulder, with back and wrist the next most common problem areas. 61% of respondents report pain or discomfort in three or more areas with a third reporting recurrent flare-ups of a problem while their pain is either staying the same or getting worse over time.
Considering these figures while at your next rehearsal, the chances are very high that the person next to you is in some kind of physical distress while playing, at least some of the time. And the discomfort isn’t always over “when the fat lady sings”, with 92% of respondents still experiencing issues post performance.
That musicians experience playing-related discomfort from the earliest years and then can go on to reach professional level while enduring continuing or increasing problems is cause for concern.
The student interviewed in the Body Sphere program was fortunate to be provided with a well-being course at his college. As a result, playing without injuring oneself is something that he realises he is “starting to be convinced … might be possible”. The second student adds, “ the more I think about this well-being program, it just seems so silly that it doesn’t happen everywhere”.
When the research proves that movement health is at issue for so many performing musicians, it is difficult to accept the situation where students with many years of tuition behind them, reach a high level of performance with little or no exposure to a “well-being” approach. Establishing and preserving healthy movement in music teaching and performance programs is clearly not given serious, sustained priority in spite of the fact that playing-related movement issues can severely compromise or even terminate a career. To address this problem requires a major rethink at every level of a musician’s education and training. As performing musicians we wholeheartedly accept technical and expressive facility as worthy of development and refinement over the span of a lifetime of playing. Ensuring that skills in healthy movement are promoted as equally deserving would be an evolutionary first step.
My own musical education, like that of many of my contemporaries, did little to equip me with knowledge or skills to deal with any pain or discomfort that I encountered as a result of my playing. Nor could it act as a model for teaching in a way that integrated wellbeing into instrumental technique. My experience as a student was of the “masterclass” tradition, where knowledge is passed, sometimes unquestioningly, from one generation of players to the next. It was all I’d known when it came to the teacher-pupil relationship and while my musicianship benefited greatly as a result, the tradition did not ensure my health. To find a different perspective on playing and teaching I had to look outside the traditional music setting for comprehensive, quality information.
I first engaged with Alexander Technique almost a quarter of a century ago and was convinced of the wisdom in equipping musicians with movement skill, both for the health benefits and the added bonus of the skill enhancement it produced. Instinctively I knew that tailoring the information specifically to music making was necessary, if this was ever going to make a positive change in the culture of music teaching.
Later I chose to pursue study in Body Mapping with Andover Educators, an organisation of musicians committed to saving, securing and enhancing musical careers by providing accurate information about the body in movement. Their mission is to place music education on a secure somatic foundation – a very different approach than the way music has been taught over centuries now. The term “somatic” refers to sensing the body in movement and so it follows that the music student is encouraged to add their sensory input to the teaching equation, to ‘listen’ not just to the sound they are producing, but also, to the kinaesthetic information coming from their own experience of moving to play.
Informed and enhanced by practical information in anatomy and movement design, musicians are taught to trust their kinaesthetic experience as the basis for engaging the body’s mechanisms of balance and support. This method of movement re-education fits like a glove into the practice and teaching of an instrument and allows it to become an essential approach, not something viewed as adjunct to mainstream tuition. Being fully integrated into the teaching studio also ensures Body Mapping can withstand changing priorities in programming and budget cuts within institutions. Ultimately we can grow professional performers and music teachers who naturally and independently include healthy movement in the way they approach each modality of their art.
In the same spirit of respecting each musician’s unique experience, the BMA survey has used a self-reporting method for the collection of data from its participants. Self-reporting assists in drawing out an individual’s account of discomfort and can help the study to detect mild symptoms that can act as the body’s warning signal in response to the threat of more serious injury. Self-reporting can also throw up some anomalies that may offer insight into how an individual is evaluating the significance of playing-related discomfort.
While answering ‘never’ to experiencing pain during or after playing, a respondent may go on to answer that they did indeed experience playing-related pain in the back and wrist. Some respondents reported that movement quality had no impact on their performance and yet nominated movement as affecting several of the elements of performance as listed in the survey question. The segregation of our actual physical experience of playing from the outcome achieved may well reflect how we were taught to assess ourselves as performers. If we fail to examine the connection of our kinaesthetic experience, especially discomfort or pain, with the quality of sound we produce, we are essentially becoming deaf to our body. How loud must the noise become before we respond? Holding off until requiring medical or other serious and costly intervention does not seem a sensible approach to management.
Cultural themes add complexity to this situation. We live in the age of recording where an artificial perfection, particularly in ‘reproductive’ classical music performance, can seem the norm for many listeners. Classical music carries the concept of “error” where predefined expectations and constraints are placed on a performer. Some of these originate from the score itself, the history of recorded performances of a piece and from the audience, who can buy recordings and compare performers. The artist is increasingly reduced to a commodity in a marketplace, with a value that is rated as “bankable” or not by management. The pressure to be ‘note perfect’ can undermine more artistic goals of seeking a perfect connection to our music and audience.
It is regrettable that disclosure of a musculoskeletal health issue in such a competitive environment can have negative impacts. Many musicians understandably wish to avoid appearing injury-prone or blemishing a hard-earned reputation that is closely tied with work opportunities. The consequent underreporting of problems ends up limiting exposure to early intervention and does little to improve the health outcomes of an individual or those of the profession as a whole. Musicians may be staying silent on their own suffering or that of a professional colleague when dealing with management, while simultaneously using medication for pain (7% of BMA survey respondents) or seeking out physical and alternative therapies for respite (79%).
The survey shows that a large majority of respondents believe that movement is impacting their endurance, their technical facility and their enjoyment in performance. Three quarters are feeling the impact of playing-related pain on the rest of their lives.
It’s clear that solving the issue of movement health for musicians is pivotal to bringing individuals and the profession as a whole to a better place. As in other professional fields, preventative training can support us in the freedom to pursue our work pain-free. A skill set in healthy movement can address existing issues in concert with delivering ongoing benefits for the next generation of aspiring musicians. To be embodied performers is to play our part in the beginnings of a healthier paradigm in music education.
Jane Shellshear has a Bachelor of Music in Performance from Sydney University and pursued postgraduate studies at the Royal Northern College in Manchester and in London. Through presentations, workshops and lessons she works with musicians and others to develop healthy movement patterns through the practice of Alexander Technique and Body Mapping. Jane is a member of the Australian Society of Teachers of the Alexander Technique (AUSTAT) and the Australian Society for Performing Arts Healthcare (ASPAH).