red flag

Musicians and Injuries: Another Kind of Choice

Musicians are used to making choices about many things. Some of these choices, like tempi, intonation, tone color, dynamics, and vibrato, are musical. Some are movement choices, since every sound we make as musicians is a result of movement somewhere.  Another area where musicians have a choice is in how they deal with discomfort, pain and injury. There is a negative stigma around injury in the performing arts world and that needs to change. Part of what we lack is transparency. Musicians don’t want to talk about this, but it’s vitally important that we do so.  As I was preparing to give a short guest presentation to first-semester string students, I asked my current students what was the the single most important thing I could say to brand new string students. Their response was, “The stuff about injury and the red flag slide.”  So, that’s what I’m going to share with you here. In addition, I’ve been thinking about injury and recovery since I had a wrist surgery on February 3. More about that later, but if you’re curious, I’ve been posting videos on my Instagram feed @precisionperformanceandtherapy to document the healing process. Knowledge is power.

Let’s talk about the actual rates of injury among professional musicians. In 2012, Dr. Bronwen Ackerman, Professor of Biomedical Science at the University of Sydney, surveyed members of the eight professional full time orchestras in Sydney. The study found that 70% of orchestral musicians will experience an injury during their lifetime and 82-97% of orchestral musicians experience some type of injury in a 12-month period.1 Another study, done in 2008 by the American Association of Physician Assistants, found that 50-76% of musicians reported musculoskeletal injuries.2 44% of singers have a vocal condition and 69% have a vocal disability in a 12-month period.3 In comparison, a 2009 study found that the injury rate for Cirque du Soleil artists was 9.7% compared to a 15.2% injury rate for NCAA collegiate women’s gymnasts.4

Does an injury rate of 50-97% for professional musicians, depending on what study is referenced, seem alarming to you? The actual numbers are probably higher because performing artists don’t disclose this type of information easily, circling back to the negative stigma I mentioned earlier.

Dr. Ackerman was a guest on Karen Bulmer’s podcast “Music, Mind and Body” and this episode [] is required listening in my class. I think every performing artist should listen to this.  Full disclosure – Dr. Ackerman was the Keynote speaker at the 2019 ABME conference and is one of the leading researchers in the world on musicians’ health and wellness.  On the podcast, she said that it’s not really if you’re going to get hurt as a musician; it’s when and what are you going to do about it.  

Let’s compare and contrast what we know about musicians and athletes in terms of injury. I am a proud Buffalo Bills football fan, having grown up in upstate New York. If Josh Allen, the quarterback, has a sore thumb on his throwing arm, the entire Buffalo Bills training staff knows about it immediately. If Stefon Diggs goes down with a torn ACL (anterior cruciate ligament) in his knee, he’s not waiting for 2 months to get an MRI and onto the surgical schedule. As soon as the surgery finishes or the injury is diagnosed, the athlete has immediate access to high quality medical professionals including physical therapists, occupational therapists, nutritionists, athletic trainers and strength/conditioning coaches. At least part of this paradigm of care is related to finances. If these athletes aren’t on the field playing, then the organization isn’t making money. Athletes accept that injury risk comes with the job and they do the work to heal, rehab, and get back on the field. They don’t ever think, “I’m a terrible football player because I blew out my knee or fractured a bone in my hand.” 

Musicians, on the other hand, are part of a culture that has a negative and secretive view of injury.

We continue to struggle through pain because we need to work.  It’s simple math – if you don’t play the gig, you don’t get paid and we all need to eat and pay our bills. If we don’t show up to the gig, they hire a sub and you might not get called back. Many musicians don’t have adequate health insurance, which can contribute to the fact that musicians typically don’t seek out medical care until the “thing” is so bad, that they cannot play. Instead of going to medical professionals, we ask other musicians or studio professors. Why are we so afraid, as a group, to seek medical guidance? In my experience, singers are much better about this. They understand much more about how their body is their instrument and how they cannot continue to sing when they don’t feel well. We could and should learn from the singers in our lives.

In the same podcast I referenced previously, Dr. Ackerman says that if musicians went to see medical providers when the problem was just starting, as opposed to waiting until it’s a HUGE problem, that the “thing” is generally more easily managed and outcomes are better. Musicians need to accept that things happen and when they do, it doesn’t mean we’re bad musicians. It simply means that there’s a problem that needs to be solved.

It is not ok for you to be in pain when you are singing or playing your instrument. Period. Pain is your body’s request for change. In my class, I have students will all sorts of the things going on. That’s one of the main reasons they take my body mapping course – they are trying to solve a problem.  Sometimes, there’s soreness from overuse that resolves with time. But how much time? What kind of soreness? My students want to know what type of things, red flags, which require medical consultation.

The following list of bullet points is shared frequently when I’m presenting. For many of my college students, this is the #1 piece of information that they learn in my class. The following list of red flags, developed with Dr. Mark Erickson for a joint webinar we presented, comes from his work as a physical therapist and information from the “Essentials of Performing Arts Medicine Course” from Summer 2020.

Red Flags 

~ New pain that doesn’t go away with rest

~ Recurrent pain that has not diminished within 2 weeks

~ Tingling, numbness, loss of motor control

~ Throbbing, gnawing pain that keeps you up at night

~ Hoarseness or noticeable voice changes for longer than 2 weeks without associated illness

~ Acute/traumatic loss of/change in voice

There is good news here. Injuries can heal. You can retrain your movement and get back to playing your best. When you need a surgeon or physical therapy, nothing else will do. As a movement educator and massage therapist, part of my job is to refer musicians with pain to the appropriate medical professionals. Medical problems must be ruled out. Some times, musicians see medical providers, have a bunch of tests and scans and are told that there’s nothing wrong. Often, but not always, this comes with the advice to just stop playing for a while. You take some time off (or not), start to feel better and then the problem comes right back. This is because you didn’t change the movement pattern than led to the injury. This is where movement education can play a big part, but only after medical issues have been ruled out. Musicians with injuries need a team of providers, just like the athletes, to get back to playing their best. The wellness team should include orthopedic surgeons, physical therapists, occupational/hand therapists, mental health providers, movement educators such as licensed body mapping educators, Alexander Technique teachers, Feldenkrais practitioners, massage therapists, and personal trainers. We need to advocate early, often, and aggressively for quality health care when we need it. And we need to stop beating ourselves up when injuries happen. We’re all humans doing the best we can and sometimes we need help. At the most basic level, it really is that simple. 

1. Ackermann B, Driscoll T, Kenny DT. Musculoskeletal pain and injury in professional orchestral musicians in Australia. Medical Problems of Performing Artists. 2012;27(4):181

2. Heinan M. A review of the unique injuries sustained by musicians. Journal of the American Academy of Physician Assistants. 2008; 21(4), 45-6, 48, 50.

3. Phyland D, Oates J,Greenwood KM. Self-reported voice problems among three groups of professional singers. Journal of Voice. 1999;13(4):602-611.

4. Shrier, I., Meeuwisse, W.H., Matheson, G.O., Wingfield, K., Steele, R.J., Prince, F., Hanley, J., & Montanaro, M. Injury patterns and injury rates in the circus arts: an analysis of 5 years of data from Cirque du Soleil. American Journal of Sports Medicine. 2009:37(6),1143-9.

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