Performance Injuries

In 1838 Robert Schumann wrote, "All the music is complete and alive within me, so that I wish to effortlessly breathe it out, but now I can hardly bring it forth; I trip over one finger with the other. This is truly frightening and has already caused me much pain." Schumann's statement speaks to the frustration of artists who suffer with a condition that hinders their ability to make music and earn a living.

Like athletes, musicians perform for the public; and like professional athletes, they could lose their jobs if they do not perform. Published calculations report that over the course of their careers, as many as 76% of orchestra musicians have suffered, or will suffer, some debilitating condition which will affect their ability to perform on their instruments.

Anyone who performs on a musical instrument has the potential to suffer injury related to that activity. Instrumental musicians are at risk for repetitive motion injuries. Sizable percentages of them develop physical problems related to playing their instruments; and if they are also computer users, their risks are compounded. Instrumental injuries often include carpal tunnel syndrome, tendinitis, and bursitis. Incorrect posture, non-ergonomic technique, excessive force, overuse, stress, and insufficient rest contribute to chronic injuries that can cause great pain, disability, and the end of careers.

What Instrumentalists Should Do

The School of Music thanks the Associated Board of the Royal Schools of Music and the Canadian Network for Health in the Arts for the following information:

  1. Evaluate your technique. Reduce force, keep joints in the middle of their range of motion, use large muscle groups when possible, and avoid fixed, tense positions.
  2. Always warm up. As an athlete would not begin a vigorous physical activity without warming up, a musician must warm up carefully before practice or performance.
  3. Take breaks to stretch and relax. Take short breaks every few minutes and longer breaks each hour. Two or more shorter rehearsals each day are more productive than marathon single sessions. Even in performance, find those opportunities to relax a hand, arm, or embouchure to restore circulation.
  4. Pace yourself. No pain, no gain is a potentially catastrophic philosophy for a musician. Know when enough is enough, and learn to say 'no' to certain performances or lengths of performing that might result in injury.
  5. Check out your instrument. Does your instrument place undue stress on your body? Is your instrument set up optimally for you to relieve pressure on hands, joints, etc.? Is there a strap, carrier, or stand available to relieve the stress?
  6. Evaluate other activities. Pains and injuries affecting your music making could be caused by other activities in your daily life. Computer use is notorious for causing afflictions including carpal tunnel syndrome and tendinitis.
  7. Pay attention to your body. Pain is the mechanism by which your body tells you that something is wrong. Listen to your body; if it hurts, stop what you are doing.
  8. Get medical attention. Do not delay in seeing a doctor. A physician may prescribe a minor adjustment or, in worst-case scenarios, stipulate not performing for a period of time. As drastic as this may sound, a few months of rest is better than suffering a permanent, career ending injury.

Likewise, the demands placed on singers' voices are immense. Hardly a month goes by where a top singer is not forced to interrupt a tour, take a break, or undergo a medical procedure due to problems with their voice. Medical professionals are making the case that the demands put on one's voice when singing one to three hours is as intense as those made on an Olympic marathon runner's body. Additional factors such as nutrition, smoking, drug use, noisy environments, and proper voice training (or the lack of it) all play a role in a singer's ability to perform at her/his best.

What Singers Should Do

The School of Music thanks The Singer's Resource, the Texas Voice Center, Houston, and the University of Michigan Vocal Health Center for the following information:

  1. Maintain good general health. Get adequate rest to minimize fatigue. If you do become ill, avoid "talking over your laryngitisee" - see your physician and rest your voice.
  2. Exercise regularly.
  3. Eat a balanced diet. Including vegetables, fruit and whole grains, and avoid caffeinated drinks (coffee, tea, and soft drinks) and alcohol. Avoid spicy, acidic, and dairy foods if you are sensitive to them.
  4. Maintain body hydration; drink two quarts of water daily.
  5. Avoid dry, artificial interior climates. Las Vegas has an average daily humidity of 36%, a relatively low amount of moisture. Using a humidifier at night might compensate for the dryness.
  6. Limit the use of your voice. High-ceilinged restaurants, noisy parties, cars and planes are especially damaging to the voice. If necessary, use amplification for vocal projection.
  7. Avoid throat clearing and voiced coughing.
  8. Stop yelling, and avoid hard vocal attacks on initial vowel words.
  9. Adjust the speaking pitch level of your voice. Use the pitch level in the same range where you say, "Umm-hmm?"
  10. Speak in phrases rather than in paragraphs. Breath slightly before each phrase.
  11. Reduce demands on your voice – don't do all the talking!
  12. Learn to breathe silently to activate your breath support muscles and reduce neck tension.
  13. Take full advantage of the two free elements of vocal fold healing: water and air.
  14. Vocal athletes must treat their musculoskeletal system as do other types of athletes; therefore, vocal warm-ups should always be used prior to singing. Vocal cool-downs are also essential to keep the singing voice healthy.

What All UNLV Musicians Should Do

  1. Stay informed. Awareness is the key. Like many health-related issues, prevention is much easier and less expensive than cures. Take time to read available information concerning injuries associated with your art.

    Musicians might find the following books helpful:

    • Conable, Barbara. What Every Musicians Needs to Know About the Body (GIA Publications, 2000)
    • Klickstein, Gerald. The Musician's Way: A Guide to Practice, Performance, and Wellness (Oxford, 2009)
    • Norris, Richard N. The Musician's Survival Manual (International Conference of Symphony and Opera Musicians, 1993)

    The following links may be useful:

  2. Given the opportunity, students should enroll in UNLV's course MUS 480/680, The Healthy Musician. The course is offered each spring semester. Instructed by Dr. Stephen Caplan, Professor of Music and certified Andover Educator, this class studies auditory, vocal, mental and neuromusculo-skeletal health, focusing on health preservation and injury prevention among musicians, including performance anxiety issues.